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The Tasmanian Atrial Fibrillation Study: Transition to direct oral anticoagulants 2011-2015


Alamneh, EA and Chalmers, L and Bereznicki, LR, The Tasmanian Atrial Fibrillation Study: Transition to direct oral anticoagulants 2011-2015, Cardiovascular Therapeutics, 35, (3) Article e12254. ISSN 1755-5922 (2017) [Refereed Article]

Copyright Statement

Copyright 2017 Wiley

DOI: doi:10.1111/1755-5922.12254


Introduction: Contemporary Australian data regarding antithrombotic prescribing patterns following approval of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) are limited.

Aim: The aim of the present study was to assess antithrombotic prescribing patterns before, during and after the clinical introduction of DOACs.

Methods: Using digital medical records, this retrospective cohort study included all patients with AF as a primary or secondary diagnosis who were admitted to the Royal Hobart Hospital, Tasmania, Australia, between January 2011 and July 2015.

Results: Antithrombotic agents were prescribed for 2078 (91.9%) of 2261 patients without documented contraindication to therapy. Higher rates of OAC prescribing were observed following Government subsidization of DOACs in Quarter 3 (Q3) 2013 than anticoagulation rates in the prior quarters, (54.4% in Q3, 2013 to 68.1% in Q2, 2015, p < 0.001), with the prescribing of warfarin and antiplatelet agents declining. DOACs, as a class, accounted for 18.4% of patients on antithrombotic therapy in 2011 -2015; the proportion of patients receiving a DOAC steadily increased from 3.9% among OAC users in Q3, 2011 to 67.6% in Q2, 2015 (p < 0.001). In a sub-set of patients with newly diagnosed AF, patients commenced on DOACs were younger (70.4 vs. 73.8 years, p = 0.04) and had lower stroke and bleeding risk scores (CHA2DS2-VASc 2.8 vs. 3.3, p = 0.03, HAS -BLED 2 vs. 3, p  = 0.04) than patients who were newly prescribed warfarin.

Conclusions: DOACs rapidly became the most commonly prescribed class of antithrombotic medications in patients with AF soon after they became widely available. Warfarin and antiplatelet prescribing declined significantly, although a substantial proportion of patients continued to be prescribed antiplatelet therapy. Patients who were initiated on DOACs were typically younger with fewer comorbid conditions compared to those initiated on warfarin therapy.

Item Details

Item Type:Refereed Article
Keywords:elderly, antiplatelet agents, atrial fibrillation, direct oral anticoagulants, warfarin
Research Division:Biomedical and Clinical Sciences
Research Group:Pharmacology and pharmaceutical sciences
Research Field:Clinical pharmacy and pharmacy practice
Objective Division:Health
Objective Group:Other health
Objective Field:Other health not elsewhere classified
UTAS Author:Alamneh, EA (Dr Endalkachew Alamneh)
UTAS Author:Chalmers, L (Dr Leanne Chalmers)
UTAS Author:Bereznicki, LR (Professor Luke Bereznicki)
ID Code:114374
Year Published:2017
Web of Science® Times Cited:18
Deposited By:Pharmacy
Deposited On:2017-02-14
Last Modified:2018-07-25

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