Switching warfarin to direct oral anticoagulants in atrial fibrillation: Insights from the NCDR PINNACLE registry
| Autor: | James V. Freeman, Lucas N. Marzec, Yue Zheng, Yang Song, Salim S. Virani, Christopher Sciria, Nihar R. Desai, Thomas M. Maddox, Amarnath Annapureddy, Gheorghe Doros, Jane J. Lee, Ali W O’Hare, Christopher P. Cannon, Yuyin Liu, Lina Vadlamani, Ramesh Daggubati, Benjamin Rodwin |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Clinical Investigations Administration Oral Context (language use) 030204 cardiovascular system & hematology direct oral anticoagulants Dabigatran 03 medical and health sciences chemistry.chemical_compound Sex Factors 0302 clinical medicine Edoxaban Internal medicine Atrial Fibrillation Ethnicity medicine Humans Prospective Studies Registries patterns of care 030212 general & internal medicine Prospective cohort study Aged Rivaroxaban business.industry Age Factors Warfarin Anticoagulants practice patterns Atrial fibrillation General Medicine Middle Aged medicine.disease Stroke Treatment Adherence and Compliance warfarin Treatment Outcome chemistry Female Apixaban Cardiology and Cardiovascular Medicine business Follow-Up Studies medicine.drug |
| Zdroj: | Clinical Cardiology |
| ISSN: | 1932-8737 0160-9289 |
| DOI: | 10.1002/clc.23376 |
| Popis: | Background Previous studies examining the use of direct oral anticoagulants (DOACs) in atrial fibrillation (AF) have largely focused on patients newly initiating therapy. Little is known about the prevalence/patterns of switching to DOACs among AF patients initially treated with warfarin. Hypothesis To examine patterns of anticoagulation among patients chronically managed with warfarin upon the availability of DOACs and identify patient/practice‐level factors associated with switching from chronic warfarin therapy to a DOAC. Methods Prospective cohort study of AF patients in the NCDR PINNACLE registry prescribed warfarin between May 1, 2008 and May 1, 2015. Patients were followed at least 1 year (median length of follow‐up 375 days, IQR 154‐375) through May 1, 2016 and stratified as follows: continued warfarin, switched to DOAC, or discontinued anticoagulation. To identify significant predictors of switching, a three‐level multivariable hierarchical regression was developed. Results Among 383 008 AF patients initially prescribed warfarin, 16.3% (n = 62 620) switched to DOACs, 68.8% (n = 263 609) continued warfarin, and 14.8% (n = 56 779) discontinued anticoagulation. Among those switched, 37.6% received dabigatran, 37.0% rivaroxaban, 24.4% apixaban, and 1.0% edoxaban. Switched patients were more likely to be younger, women, white, and have private insurance (all P |
| Databáze: | OpenAIRE |
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