Background
Anticoagulation reduces stroke risk in patients with atrial fibrillation (AF) but
under-prescribing in eligible patients has been commonly reported. Introduction of
the direct acting oral anticoagulants (DOACs) was considered to potentially improve
prescribing due to increased anticoagulant options. At the time of release to the
Australian market, there were limited studies investigating anticoagulant usage during
hospitalisations for AF. Therefore, the aim of this study was to investigate prescribing
of oral anticoagulants during hospitalisation admissions for AF during the time of
DOAC introduction to the Australian market.
Method
A retrospective study was conducted of admissions to a tertiary Queensland hospital
during 1 July 2012 to 10 June 2015. Patients were categorised according to oral anticoagulant
therapy on both hospital admission and discharge. Changes to therapy and patient factors
associated with prescribing were analysed.
Results
A total of 1,911 patients were included with 3,396 admissions during the study period.
There was a significant increase in the number of patients initiated on anticoagulant
therapy during their first admission with higher rates of initiation of DOACs compared
to warfarin. Ischaemic heart disease and high bleed risk were significantly associated
with reduced prescribing of anticoagulant therapy on first and second admission respectively,
while patients with a history of stroke or transient ischaemic attack were significantly
more likely to receive therapy.
Conclusion
The introduction of the DOACs to the Australian market increased initiation of anticoagulants
to hospitalised patients with AF across all stroke risk categories. The availability
of greater anticoagulant options has increased initiation of therapy but there remains
potential to further optimise anticoagulant prescribing by targeting therapy according
to guidelines and patient factors.
Keywords
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Article info
Publication history
Published online: April 01, 2020
Accepted:
March 8,
2020
Received in revised form:
February 20,
2020
Received:
January 14,
2020
Identification
Copyright
© 2020 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
