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Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

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Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
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Class III antiarrhythmic drugs are a group of medications that can prolong action potentials in the heart. They achieve this by blocking potassium channels or enhancing inward currents from sodium channels. However, these drugs have a unique property of "reverse use-dependence," which is most pronounced at slower heart rates and can lead to torsades de pointes—a specific type of arrhythmia. However, it is essential to note that excessive QT interval prolongation—a measure of...
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  11. Prescription And Switching Patterns Of Direct Oral Anticoagulants In Patients With Atrial Fibrillation

Prescription and switching patterns of direct oral anticoagulants in patients with atrial fibrillation

Tim A C de Vries1,2,3,4, Roisin Bavalia5, Gordon Chu6,7

  • 1Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, the Netherlands.

Research and Practice in Thrombosis and Haemostasis
|September 17, 2024

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View abstract on PubMed

Summary
This summary is machine-generated.

Direct oral anticoagulants (DOACs) like apixaban and rivaroxaban are increasingly prescribed for atrial fibrillation (AF) patients. Seven percent of patients switch OACs within a year, influenced by the initial DOAC choice and dosage.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Direct oral anticoagulants (DOACs) are crucial for managing atrial fibrillation (AF).
  • Patterns of DOAC selection and switching among OAC-naive AF patients remain unclear.
  • Understanding these patterns is vital for optimizing anticoagulation therapy.

Purpose of the Study:

  • To analyze temporal trends in the initial prescription of DOACs for OAC-naive AF patients.
  • To determine the incidence of switching to a different oral anticoagulant (OAC) within one year.
  • To identify predictors associated with switching OACs in this population.

Main Methods:

  • Retrospective cohort study utilizing a nationwide prescription registry in the Netherlands.
  • Analysis of monthly DOAC prescription data from November 2015 to November 2019.
Keywords:
anticoagulantsatrial fibrillationbig datadrug substitution

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  • Robust Poisson regression employed to identify predictors of switching within one year.

    • Main Results:

    • Apixaban, rivaroxaban, and edoxaban prescriptions increased, while dabigatran decreased.
    • Among 66,090 patients with one-year follow-up, 7% switched OACs.
    • Initial DOAC choice (dabigatran, edoxaban) and standard dosing predicted switching.

    Conclusions:

    • Factor Xa inhibitors are increasingly favored for OAC-naive AF patients in the Netherlands.
    • Initial DOAC selection and dosage significantly predict switching within the first year.
    • These findings highlight the need for personalized OAC selection strategies.
    thromboembolism