March 1, 2020Circulation Cardiovascular Quality and Outcomes
Effectiveness and Safety of Direct Oral Anticoagulants in Relation to Temporal Changes in Their Use
Why the study?
Since the introduction of DOACs, OAC prescription patterns have rapidly changed in AF, but how evolving trends and shifting patient profiles affect clinical outcomes was unclear.
Does DOAC reduce the risk of a composite clinical outcome compared to warfarin in OAC-naive patients with atrial fibrillation across different time periods?
Population
OAC-naive AF patients divided into 3 cohorts (n=35 353, n=36 631, n=44 819) in South Korea
Comparison
DOAC vs warfarin across 3 consecutive time periods
Design
Nationwide retrospective cohort study with propensity score weighting
Authors
Discussion
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Member takes
Implication
Should not yet change practice; leaves open whether durable DOAC net benefit over warfarin is causal in real-world AF.
Structured PICO
Does DOAC reduce the risk of a composite clinical outcome compared to warfarin in OAC-naive patients with atrial fibrillation across different time periods?
P
Population
116,803 oral anticoagulant (OAC) naive patients with atrial fibrillation from the Korean Health Insurance Review and Assessment database, divided into 3 cohorts by enrollment period between January 2015 and December 2017 (n=35,353 in cohort 1, n=36,631 in cohort 2, and n=44,819 in cohort 3).
I
Intervention
Direct oral anticoagulants (DOAC)
C
Comparator
Warfarin
O
Outcome
Composite outcome (components not specified in abstract)composite
DOACs maintain a consistent net clinical benefit over warfarin in real-world practice, despite temporal shifts in the clinical profiles of patients prescribed these medications.
Cite This Study
Lee et al. (2020) studied this question.