Key result
Apixaban carries the lowest 12-month switching rate among AFib oral anticoagulants at ~3%.
Why the study?
The study assessed switching patterns of oral anticoagulants in patients with atrial fibrillation following the widespread availability of direct-acting oral anticoagulants.
What are the rates and predictors of switching oral anticoagulants in patients with atrial fibrillation?
Cohort (n=15,020)
Yes
What are the rates and predictors of switching oral anticoagulants in patients with atrial fibrillation?
In Australian general practice, switching between oral anticoagulants in AF patients is low (5.7% at 12 months), with apixaban having the lowest switching rate and kidney disease being a key determinant.
Low switching rates may support OAC stability in AF; leaves open predictors such as kidney disease for prospective confirmation.
BACKGROUND: We assessed switching patterns of oral anticoagulants (OACs) in patients with atrial fibrillation (AF) in the period following widespread availability of the direct-acting oral anticoagulants (DOACs). RESEARCH DESIGN AND METHODS: A retrospective cohort study was conducted using NPS MedicineWise's MedicineInsight dataset, collected from Australian general practices. Patients with AF who newly commenced an OAC between 1 January 2013 and 30 September 2017 were included. The switching rate was calculated within 12 months post-initiation. Switching rates between OACs were compared, and predictors of switching were identified. RESULTS: We included 15,020 patients who were recorded as having been commenced on warfarin or a DOAC. Overall, 5.7% of patients switched their OAC within 12 months. The switching rates from warfarin, apixaban, dabigatran and rivaroxaban were 9.4%, 2.6%, 8.9% and 4.0%, respectively. Compared to apixaban, commencement on warfarin, dabigatran or rivaroxaban was associated with a higher risk of switching to another OAC. Patients with an estimated glomerular filtration rate (eGFR) <30 mL/min were more likely to switch from DOACs to warfarin and less likely to switch from warfarin, compared to those with an eGFR >60 mL/min. CONCLUSION: There was a low switching rate between OACs in Australian general practice patients with AF. A key determinant of switching appeared to be kidney disease.
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Kefale et al. (2022) conducted a cohort in Atrial fibrillation (n=15,020). Oral anticoagulants (OACs) was evaluated on Switching rate within 12 months post-initiation. Oral anticoagulants for atrial fibrillation had an overall 12-month switching rate of 5.7%, with specific rates of 9.4% for warfarin, 2.6% for apixaban, 8.9% for dabigatran, and 4.0% for rivaroxaban.
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