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Published on: February 28, 2012
Temporal trends in anticoagulation management for US active duty personnel with atrial fibrillation
Andrea Nichole Keithler1, Andrew S Wilson1, Alexander Yuan1
1Division of Cardiology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
Insights
Anticoagulant use in US military members with atrial fibrillation (AF) is low, with increasing direct oral anticoagulant (DOAC) prescriptions. Deployment and retention rates were similar across anticoagulant groups.
Area of Science:
- Cardiology
- Military Medicine
- Pharmacology
Background:
- Atrial fibrillation (AF) affects active duty (AD) military members.
- Anticoagulation (AC) is crucial for preventing stroke in AF patients.
- Understanding AC trends in the military is important for patient care and readiness.
Purpose of the Study:
- To investigate temporal trends of systemic anticoagulation (AC) prescriptions in US active duty (AD) military members diagnosed with atrial fibrillation (AF).
- To examine the association between AC prescriptions and military dispositions and deployment rates in this population.
Main Methods:
- Retrospective analysis of Tricare pharmacy data from January 2004 to July 2019.
- Inclusion of AD individuals diagnosed with non-valvular AF.
- Statistical analysis using chi-squared, Fisher's exact test, and t-tests.
Main Results:
- 386 AD personnel with non-valvular AF were analyzed; most had paroxysmal AF and low stroke/bleeding risk scores.
- Warfarin was prescribed to 33% and direct oral anticoagulants (DOACs) to 15%.
- DOAC utilization significantly increased over time, surpassing warfarin. Military retention and deployment rates did not differ significantly between AC groups.
Conclusions:
- This is the first study on AC utilization in US AD military members with AF.
- AC prescriptions are not common in young AD personnel with low stroke/bleeding risks.
- DOACs are increasingly preferred over warfarin for AF management in this cohort.
Abstract:
ObjectivesThis study aims to investigate US active duty (AD) military members diagnosed with atrial fibrillation (AF) and the temporal trends of systemic anticoagulation (AC). Our secondary objective is to study the AC prescriptions in AD military members diagnosed with AF and associated military dispositions and deployment rates.
Design And Setting:
A retrospective investigation of Tricare pharmacy AC prescriptions within the San Antonio Military Health System from January 2004 to July 2019 for AD individuals diagnosed with AF was performed.
Participants:
386 AD personnel with non-valvular AF were analysed (mean age 35.0±9.4 years; mean body mass index, 28.3±4.3 kg/m2; 93% male; 57% Caucasian, 94% paroxysmal AF).
Outcomes:
The temporal trends of systemic AC prescriptions were the primary outcome measures. The association between AC prescriptions and military dispositions and deployments were secondary outcomes of interest.
Statistical Analysis:
The association between AC management, future deployments and military disposition was analysed using χ2 and Fisher's exact test for categorical variables. The t-test was used for comparison of continuous variables.
Results:
CHA2DS2-VASc and HAS-BLED scores were low (0.39±0.65 and 0.86±0.63, respectively). 127 (33%) members received warfarin and 58 (15%) received direct oral anticoagulants (DOACs). Rates of military retention were not different between AC histories (no AC (64%) vs warfarin (75%) vs DOAC (65%); p=0.425). There was a significant trend of more recent utilisation of DOACs compared with warfarin (p<0.0001). When adjusted for temporal changes in deployment rates, there was no significant difference in deployment between AC groups (no AC (39%) vs warfarin (49%) vs DOAC (27%); p=0.9472).
Conclusions:
This is the first report describing AC utilisation in US AD military members with AF. Young AD personnel with low stroke and bleeding risks do not commonly receive AC prescriptions. DOAC prescription rates are increasing and predominate over warfarin for AC indications.
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