Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Sep;24(5):428-434.
doi: 10.1177/1074248419841634. Epub 2019 Apr 29.

Prescription Patterns and Outcomes of Patients With Atrial Fibrillation Treated With Direct Oral Anticoagulants and Warfarin: A Real-World Analysis

Ajoe John Kattoor  1 , Naga Venkata Pothineni  2 , Akshay Goel  2 , Mahanazuddin Syed  3 , Shorabuddin Syed  3 , Hakan Paydak  2 , Jawahar L Mehta  2
Affiliations

Prescription Patterns and Outcomes of Patients With Atrial Fibrillation Treated With Direct Oral Anticoagulants and Warfarin: A Real-World Analysis

Ajoe John Kattoor et al. J Cardiovasc Pharmacol Ther. 2019 Sep.

Abstract

Background: Direct oral anticoagulants (DOACs) have been found to be similar or superior to warfarin in reducing ischemic stroke and intracranial hemorrhage (ICH) in patients with atrial fibrillation (AF). We sought to examine the anticoagulation prescription patterns in community since the advent of DOACs and also evaluate the outcomes in terms of gastrointestinal (GI) bleeding, ischemic stroke, and ICH in real-world patients with AF receiving anticoagulation.

Methods: This is a retrospective study comprising patients who were newly diagnosed with nonvalvular AF and were prescribed anticoagulants for stroke prevention. Prescription pattern of the anticoagulants based on CHA2DS2Vasc score was studied. Clinical outcomes of GI bleeding, ischemic stroke, and ICH were analyzed using a multivariate logistic regression model.

Results: Of the 2362 patients with AF on anticoagulation, 44.7% were prescribed DOACs. Patients with CHA2DS2VASc score of ≥3 received a prescription for warfarin more often than DOACs (P < .001). Multivariate logistic regression analysis revealed that the incidence of GI bleed (odds ratio [OR]: 0.91, 95% confidence interval [CI]: 0.62-1.35, P = .66) and stroke (OR: 0.77, 95% CI: 0.57-1.05, P = .10) was similar between warfarin and DOAC users. However, there was a trend toward lower ICH in the DOAC group (OR: 0.60, 95% CI: 0.36-1.01, P = .06).

Conclusions: Prescription rate of DOACs for nonvalvular AF has increased significantly, with apixaban being the most commonly used agent. Patients with higher CHA2DS2-VASc score (≥3) are prescribed DOACs less often than warfarin. The reason for this discrepancy is unclear. Given the favorable risk-benefit profile of DOACs, further studies are needed to identify factors that determine anticoagulant selection in patients with AF with high thromboembolic risk.

Keywords: DOAC; atrial fibrillation; outcomes in atrial fibrillation; prescription pattern; warfarin.

PubMed Disclaimer

MeSH terms

LinkOut - more resources