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Thromboembolism and Mortality in the Tasmanian Atrial Fibrillation Study
Endalkachew Admassie1, Leanne Chalmers2, Luke R Bereznicki1
11 Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
Insights
Direct oral anticoagulants (DOACs) significantly reduced thromboembolic events and mortality in atrial fibrillation (AF) patients in Tasmania. Post-DOAC availability showed lower rates of stroke, TIA, and death compared to the pre-DOAC era.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Anticoagulation use in atrial fibrillation (AF) has increased, but real-world data on outcomes are limited.
- Direct oral anticoagulants (DOACs) represent a newer class of anticoagulation therapy.
- Contemporary data on thromboembolism and mortality in AF patients outside clinical trials are scarce.
Purpose of the Study:
- To assess the impact of DOACs on clinical outcomes in Tasmanian AF patients.
- To compare thromboembolic event and mortality rates before and after DOAC availability.
Main Methods:
- Retrospective review of medical records of AF patients in Tasmanian public hospitals (2011-2015).
- Comparison of outcomes between the pre-DOAC (2011-mid-2013) and post-DOAC (mid-2013-2015) periods.
- Focus on newly prescribed antithrombotic medications.
Main Results:
- Significant decrease in overall thromboembolic events (TE) from 3.2 to 1.7 per 100 patient-years (PY).
- Significant reduction in ischemic stroke/transient ischemic attack (IS/TIA) from 2.1 to 1.3 per 100 PY.
- All-cause mortality also significantly decreased from 2.9 to 2.2 per 100 PY.
Conclusions:
- Widespread availability of DOACs was associated with lower rates of thromboembolic events and all-cause mortality in AF patients.
- Increasing age, prior stroke, and the pre-DOAC era were identified as risk factors.
- Current smokers had more than double the risk of IS/TIA.
Background:
Although utilization of anticoagulation in patients with atrial fibrillation (AF) has increased in recent years, contemporary data regarding thromboembolism and mortality incidence rates are limited outside of clinical trials. This study aimed to investigate the impact of the direct oral anticoagulants (DOACs) on the clinical outcomes of patients with AF included in the Tasmanian Atrial Fibrillation Study.
Methods:
The medical records of all patients with a primary or secondary diagnosis of AF who presented to public hospitals in Tasmania, Australia, between 2011 and 2015, were retrospectively reviewed. We investigated overall thromboembolic events (TEs), ischemic stroke/transient ischemic attack (IS/TIA), and mortality incidence rates in patients admitted to the Royal Hobart Hospital, the main teaching hospital in the state. We compared outcomes in 2 time periods: prior to the availability of DOACs (pre-DOAC; 2011 to mid-2013) and following their general availability after government subsidization (post-DOAC; mid-2013 to 2015).
Results:
Of the 2390 patients with AF admitted during the overall study period, 942 patients newly prescribed an antithrombotic medication (465 and 477 from the pre-DOAC and post-DOAC time periods, respectively) were followed. We observed a significant decrease in the incidence rates of overall TE (3.2 vs 1.7 per 100 patient-years [PY]; P < .001) and IS/TIA (2.1 vs 1.3 per 100 PY; P = .022) in the post-DOAC compared to the pre-DOAC period. All-cause mortality was significantly lower in the post-DOAC period (2.9 vs 2.2 per 100 PY, P = .028). Increasing age, prior stroke, and admission in the pre-DOAC era were all risk factors for TE, IS/TIA, and mortality in this study population. The risk of IS/TIA was more than doubled (hazard ratio: 2.54; 95% confidence interval: 1.17-5.52) in current smokers compared to ex- and nonsmokers.
Conclusion:
Thromboembolic event and all-cause mortality rates were lower following the widespread availability of DOACs in this population.
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