Temporal trends in anticoagulation management for US active duty personnel with atrial fibrillation.

Autor: Keithler AN; Division of Cardiology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA., Wilson AS; Division of Cardiology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA., Yuan A; Division of Cardiology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA., Sosa JM; Division of Cardiology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA., Bush KNV; Division of Cardiology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA kelvin.n.bush.mil@health.mil.
Jazyk: angličtina
Zdroj: BMJ open [BMJ Open] 2022 Nov 29; Vol. 12 (11), pp. e049394. Date of Electronic Publication: 2022 Nov 29.
DOI: 10.1136/bmjopen-2021-049394
Abstrakt: 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/m 2 ; 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 χ 2 and Fisher's exact test for categorical variables. The t-test was used for comparison of continuous variables.
Results: CHA 2 DS 2 -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.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze: MEDLINE
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