May 20, 2017

Influence of Direct Oral Anticoagulants on Rates of Oral Anticoagulation for Atrial Fibrillation

Journal of the American College of Cardiology
Lucas MarzecThomas M Maddox

Abstract

Oral anticoagulation (OAC) with warfarin is underused for atrial fibrillation (AF). The availability of direct oral anticoagulants (DOACs) may improve overall OAC rates in AF patients, but a large-scale evaluation of their effects has not been conducted. This study assessed the effect of DOAC availability on overall OAC rates for nonvalvular AF. Between April 1, 2008 and September 30, 2014, we identified 655,000 patients with nonvalvular AF and a CHA2DS2-VASc score of >1 in the National Cardiovascular Data Registry PINNACLE registry. Temporal trends in overall OAC and individual warfarin and DOAC use were analyzed. Multivariable hierarchical logistic regression identified patient factors associated with OAC and DOAC use. Practice variation of OAC and DOAC use was also assessed. Overall OAC rates increased from 52.4% to 60.7% among eligible AF patients (p for trend <0.01). Warfarin use decreased from 52.4% to 34.8% (p for trend <0.01), and DOAC use increased from 0% to 25.8% (p for trend <0.01). An increasing CHA2DS2-VASc score was associated with higher OAC use (odds ratio [OR]: 1.06; 95% confidence interval [CI]: 1.05 to 1.07), but with lower DOAC use (OR: 0.97; 95% CI: 0.96 to 0.98). Significant practice variation was present...Continue Reading

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Mentioned in this Paper

Study
Prescribing Patterns, Physician
Anticoagulants, Oral
Negative Regulation of Coagulation
Warfarin
Decreased Coagulation Activity [PE]
Evaluation
Atrial Fibrillation
Acute Cerebrovascular Accidents
Vascular Diseases

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