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Published on: February 26, 2013
Comorbidities and Antithrombotic Treatment Pattern in Patients With Atrial Fibrillation
Oh Young Bang1, Siin Kim2, Young Keun On3
1Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Insights
The introduction of non-vitamin K antagonist oral anticoagulants (NOACs) did not significantly alter antithrombotic treatment patterns for atrial fibrillation. Comorbidities remain a key factor in selecting treatments like NOACs, warfarin, or antiplatelets.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Non-vitamin K antagonist oral anticoagulants (NOACs) offer an alternative to warfarin for stroke prevention in non-valvular atrial fibrillation (NVAF).
- Understanding current antithrombotic treatment patterns and influencing factors is crucial for optimizing patient care.
Purpose of the Study:
- To investigate treatment patterns of antiplatelet agents, warfarin, and NOACs in clinical practice.
- To identify patient factors associated with the choice of antithrombotic therapy.
Main Methods:
- Retrospective cohort study utilizing the Korean Health Insurance Review & Assessment Service database.
- Inclusion criteria: age ≥18 years, atrial fibrillation diagnosis, CHA 2 DS 2 -VASc score ≥2.
- Analysis of antithrombotic prescription patterns before and after NOAC introduction using logistic regression.
Main Results:
- Over 129,000 and 196,000 patients were analyzed before and after NOAC introduction, respectively.
- Warfarin use was associated with low HAS-BLED and high CHA 2 DS 2 -VASc scores, or prior stroke. Similar trends observed for NOACs and warfarin post-introduction.
- CHA 2 DS 2 -VASc score and stroke history influenced NOAC/warfarin use, while myocardial infarction (MI) and peripheral arterial disease favored antiplatelets.
Conclusions:
- The introduction of NOACs did not substantially change overall antithrombotic treatment patterns.
- Comorbidities, such as MI, significantly influence the choice between NOACs, warfarin, and antiplatelets, irrespective of NOAC availability.
Objective:
Non-vitamin K antagonist oral anticoagulants (NOACs) are proven alternatives to warfarin for preventing stroke in patients with non-valvular atrial fibrillation. We aimed to examine the treatment patterns and patient factors associated with the use of antiplatelet agents, warfarin, and NOACs in clinical practice.
Methods:
We conducted a retrospective cohort study using the Korean Health Insurance Review & Assessment Service database. Patients receiving antithrombotics were identified before and after the introduction of NOACs (from August 1, 2013 to December 30, 2014 and July 1, 2015 to November 30, 2016, respectively). Patients were included if they were aged ≥18 years, had an atrial fibrillation diagnosis, and had a CHA2DS2-VASc score ≥2. Treatment pattern was assessed by classifying patients into NOAC, warfarin, or antiplatelet users based on the first date of antithrombotic prescription. Clinical factors associated with the type of antithrombotics chosen were examined using logistic regression analyses.
Results:
We identified 129,465 and 196,243 patients before and after the introduction of NOACs, respectively. The proportion of antiplatelet users was 60.7 and 53.0% before and after the introduction of NOACs, respectively. The proportion of warfarin users was higher in patients with low HAS-BLED score, high CHA2DS2-VASc score, or stroke before the NOAC era. A similar trend was observed for NOAC and warfarin users after the introduction of NOAC. Compared with antiplatelets, warfarin and NOAC uses were significantly associated with CHA2DS2-VASc score and stroke, whereas presence of myocardial infarction (MI) and peripheral arterial disease were significantly associated with antiplatelets prescription. For comparisons between NOAC and warfarin, HAS-BLED and CHA2DS2-VASc scores showed significant associations with NOAC use, whereas comorbidities including MI were significantly associated with warfarin use.
Conclusions:
The treatment pattern of antithrombotics did not change with the introduction of NOACs. However, comorbidities served as an important factor in choosing treatment regardless of NOAC entry.
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