Key result
The introduction of DOACs significantly increased the initiation of anticoagulants in 1,911 hospitalized patients with atrial fibrillation, with higher rates of DOAC initiation compared to warfarin.
Why the study?
DOAC introduction was considered to potentially improve under-prescribing in AF, but limited studies investigated anticoagulant usage during hospital admissions around DOAC market release in Australia.
What are the prescribing patterns and patient factors associated with oral anticoagulant initiation during hospital admissions for atrial fibrillation following the introduction of DOACs?
Observational (n=1,911)
No
What are the prescribing patterns and patient factors associated with oral anticoagulant initiation during hospital admissions for atrial fibrillation following the introduction of DOACs?
Answers are grounded in this paper and cite their sources.
The introduction of DOACs significantly increased the initiation of oral anticoagulation in hospitalized patients with atrial fibrillation, though under-prescribing persists in patients with ischemic heart disease or high bleeding risk.
BACKGROUND: Anticoagulation reduces stroke risk in patients with atrial fibrillation (AF) but under-prescribing in eligible patients has been commonly reported. Introduction of the direct acting oral anticoagulants (DOACs) was considered to potentially improve prescribing due to increased anticoagulant options. At the time of release to the Australian market, there were limited studies investigating anticoagulant usage during hospitalisations for AF. Therefore, the aim of this study was to investigate prescribing of oral anticoagulants during hospitalisation admissions for AF during the time of DOAC introduction to the Australian market. METHOD: A retrospective study was conducted of admissions to a tertiary Queensland hospital during 1 July 2012 to 10 June 2015. Patients were categorised according to oral anticoagulant therapy on both hospital admission and discharge. Changes to therapy and patient factors associated with prescribing were analysed. RESULTS: A total of 1,911 patients were included with 3,396 admissions during the study period. There was a significant increase in the number of patients initiated on anticoagulant therapy during their first admission with higher rates of initiation of DOACs compared to warfarin. Ischaemic heart disease and high bleed risk were significantly associated with reduced prescribing of anticoagulant therapy on first and second admission respectively, while patients with a history of stroke or transient ischaemic attack were significantly more likely to receive therapy. CONCLUSION: The introduction of the DOACs to the Australian market increased initiation of anticoagulants to hospitalised patients with AF across all stroke risk categories. The availability of greater anticoagulant options has increased initiation of therapy but there remains potential to further optimise anticoagulant prescribing by targeting therapy according to guidelines and patient factors.
No takes yet. Share an insight, caveat, or question.
Rathinam et al. (2020) conducted an observational in Atrial fibrillation (n=1,911). Direct acting oral anticoagulants (DOACs) vs. Warfarin or no anticoagulant was evaluated on Initiation of oral anticoagulant therapy during hospital admission. The introduction of DOACs significantly increased the initiation of anticoagulants in 1,911 hospitalized patients with atrial fibrillation, with higher rates of DOAC initiation compared to warfarin.
Synapse has enriched 10 related papers. Consider them for comparative context: