Aspirin use was strongly associated with decreased oral anticoagulant utilization (OR 0.097) in elderly patients with nonvalvular atrial fibrillation, highlighting its inappropriate use as an alternative.
Cross-Sectional (n=11,056)
What is the current status and what are the risk factors for oral anticoagulant underutilization in elderly patients with nonvalvular atrial fibrillation in the NOAC era?
Despite the availability of NOACs, approximately one-third of elderly patients with NVAF at high risk for stroke remain undertreated with oral anticoagulants, often inappropriately receiving aspirin instead.
Odds Ratio: 0.097 (95% CI 0.085–0.11)
Tasa de eventos absoluta: 21.9% vs 73.6%
valor p: p=<0.001
Non-vitamin K antagonist oral anticoagulants (NOACs) are preferred over vitamin K antagonists (VKAs) as oral anticoagulant (OAC) therapy in patients with nonvalvular atrial fibrillation (NVAF). This study aimed to estimate the current status and risk factors of OAC underutilization in the NOAC era. A cross-sectional study using nationwide claims data was conducted. Elderly patients with NVAF at an increased risk of stroke were selected as candidates for OAC therapy before the index date (July 1, 2018). The status of anticoagulant utilization on the index date and factors influencing the use of anticoagulants was investigated in these patients. Of the 11,056 patients with NVAF who were eligible for OAC therapy, 7238 (65.5%) were receiving OAC on the index date, and 6302 (87.1%) were receiving NOACs. Patients aged ≥ 75 years had higher anticoagulant utilization than those aged 65–69 years. Among comorbid diseases, while hypertension was the most influential positive factor (odds ratio OR = 1.644; confidence interval CI = 1.445–1.869) in OAC utilization, severe renal disease was the most influential negative factor (OR = 0.289; CI = 0.200–0.416). Aspirin use had a significantly low OR (OR = 0.097; CI = 0.085–0.110) of anticoagulant use. OAC use was approximately 1.5 times higher in patients with persistent or permanent AF than in those with paroxysmal AF. Approximately one-third of patients who are recommended anticoagulation therapy do not take OACs, even though the use of NOACs has become more common. It should be widely recognized that aspirin cannot be an alternative to OACs, and anticoagulant therapy should be actively implemented.
Park et al. (Sat,) conducted a cross-sectional in Nonvalvular atrial fibrillation (n=11,056). Aspirin use vs. No aspirin use was evaluated on Oral anticoagulant utilization (OR 0.097, 95% CI 0.085-0.110, p=<0.001). Aspirin use was strongly associated with decreased oral anticoagulant utilization (OR 0.097) in elderly patients with nonvalvular atrial fibrillation, highlighting its inappropriate use as an alternative.