Why the study?
Anticoagulant treatment choice in non-valvular atrial fibrillation must be individualized according to current guidelines, prompting an assessment of anticoagulant therapy adequacy in real-world primary care.
Does the prescription of oral anticoagulants align with current indication guidelines in real-world primary care patients with non-valvular atrial fibrillation?
Cross-Sectional (n=60,978)
Yes
Does the prescription of oral anticoagulants align with current indication guidelines in real-world primary care patients with non-valvular atrial fibrillation?
Absolute Event Rate: 67.6% vs 36%
A substantial proportion of real-world oral anticoagulant prescriptions for non-valvular AF, especially DOACs, do not meet strict national prescribing criteria, emphasizing a need for better integrated eGFR and TTR tools in electronic health records.
Background: Oral anticoagulants (OAs) are the treatment to prevent stroke in atrial fibrillation (AF). Anticoagulant treatment choice in non-valvular atrial fibrillation (NVAF) must be individualized, taking current guidelines into account. Adequacy of anticoagulant therapy under the current criteria for NVAF in real-world primary care is presented. Methods: Cross-sectional study, with real-world data from patients treated in primary care (PC). Data were obtained from the System for the Improvement of Research in Primary Care (SIDIAP) database, covering 60,978 NVAF-anticoagulated patients from 287 PC centers in 2018. Results: In total, 41,430 (68%) were treated with vitamin K antagonists (VKAs) and 19,548 (32%) NVAF with direct-acting oral anticoagulants (DOACs). Inadequate prescription was estimated to be 36.0% and 67.6%, respectively. Most DOAC inadequacy (77.3%) was due to it being prescribed as a first-line anticoagulant when there was no history of thromboembolic events or intracranial hemorrhage (ICH). A total of 22.1% had missing estimated glomerular filtration rate (eGFR) values. Common causes of inadequate VKA prescription were poor control of time in therapeutic range (TTR) (98.8%) and ICH (2.2%). Conclusions: Poor adequacy to current criteria was observed, being inadequacy higher in DOACs than in VKAs. TTR and GFR should be routinely calculated in electronic health records (EHR) to facilitate decision-making and patient safety.
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Llorca et al. (2021) conducted a cross-sectional in Non-valvular atrial fibrillation (n=60,978). Direct-acting oral anticoagulants (DOACs) vs. Vitamin K antagonists (VKAs) was evaluated on Inadequate prescription of anticoagulant therapy according to current criteria.
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