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Switching of oral anticoagulants in atrial fibrillation: a cohort study using Australian general practice data
Background
: We assessed switching patterns of anticoagulants in patients with atrial fibrillation (AF) in the period following widespread availability of the direct-acting oral anticoagulants (DOACs).
Research design and methods
: A retrospective cohort study was conducted using NPS MedicineWise’s MedicineInsight dataset, collected from Australian general practices. Patients with AF who newly commenced an OAC between 1 January 2013 and 30 September 2017 were included. The switching rate was calculated within 12 months post-initiation. Switching rates between OACs were compared, and predictors of switching were identified.
Results
: We included 15,020 patients who were recorded as having been commenced on warfarin or a DOAC. Overall, 5.7% of patients switched their OAC within 12 months. The switching rates from warfarin, apixaban, dabigatran and rivaroxaban were 9.4%, 2.6%, 8.9% and 4.0%, respectively. Compared to apixaban, commencement on warfarin, dabigatran or rivaroxaban was associated with a higher risk of switching to another OAC. Patients with an estimated GFR <30 mL/min were more likely to switch from DOACs to warfarin and less likely to switch from warfarin, compared to those with an estimated GFR >60mL/min.
Conclusion
: There was a low switching rate between OACs in Australian general practice patients with AF. A key determinant of switching appeared to be kidney disease.
History
Publication title
Expert Review of Clinical PharmacologyVolume
15Pagination
351-357ISSN
1751-2433Department/School
School of Pharmacy and PharmacologyPublisher
Taylor & FrancisPlace of publication
United KingdomRights statement
© 2022 Informa UK Limited, trading as Taylor & Francis GroupRepository Status
- Restricted
