Key result
Dabigatran is linked to a ~3-fold higher risk of switching compared to other DOACs.
Why the study?
Crossover between direct oral anticoagulants has been underinvestigated despite occurring frequently in clinical practice.
What are the causes, rates, and outcomes of switching between direct oral anticoagulants in clinical practice?
Observational (n=300)
No
What are the causes, rates, and outcomes of switching between direct oral anticoagulants in clinical practice?
Switching between DOACs occurs in about 9% of patients annually, most often due to minor bleeding or noncardiovascular adverse events, and generally resolves the inciting issue without increasing cardiovascular event rates.
Switching DOACs often resolves minor issues without raising CV events; observational data leave open optimal initial selection, especially for dabigatran in the elderly.
AIMS: Crossover between direct oral anticoagulants (DOACs) has been underinvestigated, but happens frequently in clinical practice. The purpose of this study was to evaluate causes, rates and outcomes of a DOAC-to-DOAC switch. METHODS: Patients receiving their first DOAC prescription at the Anticoagulation Center, Cardiology Dept, Bologna-Bellaria Hospital in 2017-2018 were consecutively included and prospectively followed up. DOAC-to-DOAC switch was the main outcome; causes of switch (cardiovascular events and noncardiovascular drug-related adverse events) had direct biannual assessment before and after the switch. RESULTS: Among 300 patients enrolled (mean age = 79.3 years, mean follow-up = 1.5 years), with no difference in cardiovascular risk factors depending on index DOAC, 13% underwent DOAC-to-DOAC switch, minor bleeding and noncardiovascular adverse events being the most frequent causes. Dabigatran carried a three-fold increase in risk of switch compared with other DOACs, but the mean age of patients who switched was 83. Factors leading to switch resolved in 87% of cases afterwards. Annual rates of cardiovascular/noncardiovascular V events did not differ before and after the switch. CONCLUSION: DOAC-to-DOAC switch happens in 9% of patients using DOAC each year, and seems not to impact rates of cardiovascular events after switch. Dabigatran, in the elderly, might be associated with a higher risk of DOAC-to-DOAC switch. Further studies are needed to confirm the long-term safety and effectiveness of switching paradigm.
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Marchetti et al. (2020) conducted an observational in Patients receiving their first DOAC prescription (n=300). DOAC-to-DOAC switch was evaluated on DOAC-to-DOAC switch. DOAC-to-DOAC switching occurred in 13% of patients over a mean 1.5 years, with dabigatran carrying a three-fold increased risk of switching compared to other DOACs.
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