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Prescribing trends of atrial fibrillation patients who switched from warfarin to a direct oral anticoagulant

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Abstract

Direct oral anticoagulant (DOAC) agents offer several lifestyle and therapeutic advantages for patients relative to warfarin in the treatment of atrial fibrillation (AF). These alternative agents are increasingly used in the treatment of AF, however the adoption practices, patient profiles, and reasons for switching to a DOAC from warfarin have not been well studied. Through the Michigan Anticoagulation Quality Improvement Initiative, abstracted data from 3873 AF patients, enrolled between 2010 and 2015, were collected on demographics and comorbid conditions, stroke and bleeding risk scores, and reasons for anticoagulant switching. Over the study period, patients who switched from warfarin to a DOAC had similar baseline characteristics, risk scores, and insurance status but differed in baseline CrCl. The most common reasons for switching were patient related ease of use concerns (37.5%) as opposed to clinical reasons (16.5% of patients). Only 13% of patients that switched to a DOAC switched back to warfarin by the end of the study period.

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Acknowledgements

The Michigan Anticoagulation and Quality Improvement Initiative is funded by the Blue Cross Blue Shield of Michigan/Blue Care Network, which did not contribute to data collection, interpretation, or manuscript writing. Dr. Barnes is supported by the National Heart, Lung and Blood Institute (2-T32-HL007853-16).

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Authors and Affiliations

  1. Texas Heart Institute, CHI-Baylor St. Luke’s Medical Center, 6720 Bertner Ave. MC-1-133, Houston, TX, 77030, USA

    Zachary D. Hale

  2. University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Dr., Lobby A Rm 3201, Ann Arbor, MI, 48106, USA

    Xiowen Kong, Brian Haymart, Xiaokui Gu, Eva Kline-Rogers, James B. Froehlich & Geoffrey D. Barnes

  3. William Beaumont Hospital, 4600 Investment Drive Suite 200, Troy, MI, 48098, USA

    Steve Almany

  4. Huron Valley Sinai Hospital, 1 William Carls Drive, Commerce, MI, 48382, USA

    Jay Kozlowski

  5. Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI, 48202, USA

    Gregory D. Krol & Scott Kaatz

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  1. Zachary D. Hale
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  2. Xiowen Kong
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  3. Brian Haymart
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  4. Xiaokui Gu
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  5. Eva Kline-Rogers
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  6. Steve Almany
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  7. Jay Kozlowski
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  8. Gregory D. Krol
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  9. Scott Kaatz
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  10. James B. Froehlich
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  11. Geoffrey D. Barnes
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Correspondence to Zachary D. Hale.

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Disclosures

ZH, XK, BH, XG, JK, GK—none; EKR—consultant: Janssen, ACP, board member: AC Forum; SA—consulting fees/honoraria: Kona, Trice Orthopedics, Micardia; ownership/partnership/principal: Biostar Ventures, Ablative Solutions, research/research grants: Boston Scientific Watchman, Abbott Absorb trial; SK—consultant: BI, Janssen Dalichi Sankyo, Bristol Myer Squibb, Pfizer, speaker’s bureau: Janssen, Boehringer-Ingelheim, Bristol Myer Squibb, Pfizer, CSL Behring; JF—consultant Merck, Bristol Myer Squibb, Pfizer, Sanofi-Aventis, Janssen Pharmaceuticals; research grants: Fibromuscular Disease Society of America, Blue Cross/Blue Shield of Michigan; GB—consulting for Portola and Aralez, research grants from Blue Cross/Blue Shield of Michigan and BMS/Pfizer.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Hale, Z.D., Kong, X., Haymart, B. et al. Prescribing trends of atrial fibrillation patients who switched from warfarin to a direct oral anticoagulant. J Thromb Thrombolysis 43, 283–288 (2017). https://doi.org/10.1007/s11239-016-1452-2

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  • DOI: https://doi.org/10.1007/s11239-016-1452-2

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