What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Non-valvular atrial fibrillation (n=12076). Intervention: Anticoagulant therapy (DOACs and VKA) vs. No anticoagulant therapy. Primary outcome: Proportion of Af patients prescribed oral anticoagulants.

January 5, 2023Open Access

Trend of anticoagulant therapy in elderly patients with atrial fibrillation considering risks of cerebral infarction and bleeding

NTNoriko M. TsujiNihon University YTYoshimitsu TakahashiKyoto University MSMichi SakaiRitsumeikan University

Key Result

The proportion of anticoagulant prescriptions for elderly patients with non-valvular atrial fibrillation increased from 41% in 2011 to 56% in 2015, driven by a rapid increase in direct oral anticoagulant use.

Study Design

Type

Cross-Sectional (n=12,076)

Structured PICO

Population

12,076 Japanese outpatients aged 65 years or older with non-valvular atrial fibrillation, analyzed cross-sectionally using a nationwide claims database to assess prescription trends from 2011 to 2015.

Exposure

Oral anticoagulants (DOACs and VKA)

Outcome

Proportions of Af patients prescribed VKA, DOACs, and antiplatelet agents in each October from 2011 to 2015

The introduction of DOACs significantly increased the overall proportion of elderly Japanese patients with atrial fibrillation receiving anticoagulant therapy, including those at high risk for both stroke and bleeding.

Main Result

Absolute Event Rate: 56% vs 41%

Limitations

The NDB sampling dataset comprised single-month data rather than a continuous set, preventing verification of whether patients were newly prescribed DOACs or switched from VKA.
It could not be verified if CHA2DS2-VASc and HAS-BLED scores were considered at the time of prescription.
Risk scores were calculated based on disease names and drugs used, likely resulting in higher scores relative to actual risks.
Comorbidities and concomitant drugs were likely confounders but were not fully assessed in the analysis.

Abstract

Abstract The introduction of direct oral anticoagulants (DOACs) has greatly changed the use of anticoagulant therapy in patients with non-valvular atrial fibrillation (Af). Therefore, this study aimed to examine changes in the proportions of oral anticoagulant prescriptions in patients with non-valvular Af aged ≥ 65 years, taking into consideration the risk of cerebral infarction and bleeding. Anticoagulant prescriptions in outpatients aged ≥ 65 years with Af were temporally analyzed using the nationwide claims database in Japan. Trends in anticoagulant prescriptions were examined according to cerebral infarction and bleeding risk. The proportion of anticoagulant prescriptions for 12,076 Af patients increased from 41% in 2011 to 56% in 2015. An increase in DOAC prescriptions was accompanied by an increase in the proportion of anticoagulant prescriptions in each group according to the CHA2DS2-VASc and HAS-BLED scores. The proportion of anticoagulant prescriptions for patients with a high risk of developing cerebral infarction and bleeding showed a marked increase. Trends in anticoagulant prescriptions in Af patient with a CHA 2 DS 2 -VASc score ≥ 2 and HAS-BLED scores ≥ 3 showed a marked increase in DOAC prescriptions. The widespread use of DOACs greatly changes the profile the prescription of anticoagulant therapy in patients with Af.

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