PurposeAlthough warfarin has historically been the standard of care for preventing ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF), the use of direct oral anticoagulants (DOACs) is rapidly increasing. In this study, we examined the demographic and clinical characteristics of patients continuing warfarin therapy and investigated reasons for warfarin continuation.Patients and methodsEach study site consecutively registered 10 patients with NVAF who had been taking warfarin for at least 12 months. Demographic and clinical characteristics and international normalized ratio (INR) values were collected from medical records. Physicians responded to questionnaires exploring reasons for continuing warfarin therapy.ResultsOverall, 313 patients treated with warfarin were registered at 33 sites. Mean ± SD age was 76.4±9.6 years; 62.9% of patients were male. The proportion of patients with INR values in the therapeutic range was 74.6% and 48.8% among patients aged ≥70 years and <70 years, respectively. Over half of the patients (51.4%) had been advised to switch from warfarin to DOACs; the primary physician-reported reason for this recommendation was superior safety and effectiveness. However, patients reported continuing warfarin because of the high price of DOACs (47.2%) and long-term positive experiences with warfarin (31.7%). The remaining 48.6% of patients with NVAF had never been counseled by their physicians about DOACs as an alternative to warfarin. For 76% of these patients, physicians favored warfarin for medical reasons, such as impaired renal function and controlled INR, but in the remaining patients, medical reasons for continuing warfarin were lacking.ConclusionApproximately half of the patients in this study were informed of warfarin alternatives primarily for improved efficacy and safety, but elected not to change regimens because of the high price of DOACs and long-term positive experiences with warfarin. In the remaining half, physician preference or specific patient characteristics prevented a change in therapy.
PurposePatients treated with warfarin must adhere to frequent monitoring, dietary restrictions, and complicated dose adjustments. Apixaban, a direct factor Xa inhibitor, is an alternative to warfarin that may reduce patient burdens associated with warfarin therapy. However, there is limited evidence pertaining to patient satisfaction with anticoagulant therapies in Japanese patients. The purpose of this observational study was to investigate changes in patient satisfaction after switching from warfarin to apixaban.Patients and methodsNonvalvular atrial fibrillation (NVAF) patients who were scheduled to switch anticoagulants from warfarin to apixaban were enrolled and treated with apixaban for 12 weeks. Patient satisfaction was assessed before the change in medication and after 12 weeks of treatment with apixaban using the Anti-Clot Treatment Scale (ACTS), a patient-reported instrument for measuring satisfaction with anticoagulation treatment. The ACTS includes a 12-item burden scale (maximum 60 points) and a 3-item benefit scale (maximum 15 points).ResultsAmong 732 NVAF patients enrolled, the full analysis set consisted of 697 patients who completed two ACTS assessments (one before the medication change and one 12 weeks after the change). Mean (±standard deviation) patient age was 76.2±9.1 years and mean CHADS2 score was 2.5±1.3. There were no significant changes in ACTS benefit scores. However, ACTS burden scores showed significant improvements at Week 12 compared to baseline (55.6±5.3 at Week 12 and 49.7±8.7 at baseline; P<0.0001). Factors associated with changes in ACTS burden scores from the multiple logistic regression analysis were age ≥70 years (odds ratio [OR]: 1.86; 95% confidence interval [CI]: 1.12–3.10; P=0.0169), baseline ACTS burden score (OR: 0.79; 95% CI: 0.75–0.82; P<0.0001), and use of non-steroidal anti-inflammatory drugs/antiplatelet drugs (OR: 0.60; 95% CI: 0.36–1.00; P=0.0499).ConclusionSwitching from warfarin to apixaban improved patient satisfaction with anticoagulant therapy in Japanese patients with NVAF by reducing burden of treatment.
Introduction Previous studies on anticoagulation treatment trends have mostly focused on hospitalized patients. This study aimed to clarify the treatment status of patients with venous thromboembolism (VTE) in Japan from 2011 to 2018, including outpatients, and to assess adherence with current guidelines. Methods Data of inpatients and outpatients who were treated for VTE were extracted from a nationwide claims database (Medical Data Vision Co., Ltd., Tokyo, Japan) and analyzed. Results The study included 79,330 patients with VTE; half were diagnosed during hospitalization for diseases other than VTE. The proportion of outpatient treatment increased significantly from 2015 to 2018 (Cochran–Armitage trend test, P < 0.0001), while 80% were anticoagulated in hospital after pulmonary embolism (PE) diagnosis. The proportion of patients with VTE treated as outpatients was no lower than the proportion of inpatients, even in the presence of active cancer, and there were no clear differences in anticoagulant choices. Treatment with direct oral anticoagulants (DOACs) did not always include the recommended initial intensification therapy. There was wide variation in the duration of DOAC treatment and the median duration of use was shorter than that recommended in VTE treatment guidelines. Conclusion While the gradual increase in VTE outpatient treatment appears to be in line with guideline recommendations, PE outpatient treatment could be further facilitated. The large proportion of patients diagnosed with VTE during hospitalization for other conditions suggests the importance of further utilizing in-hospital manuals for thrombosis prevention. The presence or absence of cancer did not appear to affect the basic treatment strategy of anticoagulation for VTE. Future studies are expected to better define the characteristics of patients who can be safely and effectively treated in an outpatient setting, and to examine whether anticoagulation for a shorter treatment period than recommended by the guidelines or DOAC therapy without initial intensification would improve patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s40119-022-00284-4.
Introduction Evidence regarding the development of pulmonary thromboembolism (PE) during hospitalization is unclear. We hypothesized that the incidence of PE could vary depending on clinical department and aimed to conduct a survey on the incidence of in-hospital PE. Methods We conducted a retrospective analysis using claims data of in-hospital patients in Japan. We collected background information regarding patients with and without PE occurrence during hospitalization. Further, we determined the incidence of PE and implemented prophylactic procedures in patients with and without surgery according to clinical department at admission. Finally, we examined the duration of hospital stay and in-hospital mortality rates in patients with and without PE. Results We found that 5007 (0.107%, 20.61 per 1000 person-years) patients developed PE during hospitalization and differed by clinical department at admission. Moreover, 2272 (0.095%, 19.3 per 1000 person-years) and 2735 (0.119%, 21.8 per 1000 person-years) patients with and without surgery, respectively, developed PE during hospitalization ( P < 0.001). Further, 33.8% of inpatients underwent prophylactic procedures for PE; however, the implementation rate differed between patients with and without surgery (59.2% vs. 7.3%, P < 0.001). The median duration of hospital stay in patients with and without PE was 31.0 and 11.0 days, and the in-hospital mortality rates in patients with and without PE were 11.0% and 3.5%, respectively ( P < 0.001). Discussion The incidence of in-hospital PE differed according to patient characteristics, clinical departments, and presence/absence of surgery. The onset of PE during hospitalization leads to prolonged hospital stay and in-hospital death. Conclusion It is important to conduct a proper risk assessment on admission as well as to implement proper prophylactic procedures to prevent the development of PE during hospitalization. Supplementary Information The online version contains supplementary material available at 10.1007/s40119-022-00290-6.
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