Atrial fibrillation decision support tool: Population perspective

Abstract

Background Appropriate thromboprophylaxis for patients with atrial fibrillation or atrial flutter (AF) remains a national challenge. The recent availability of direct oral anticoagulants (DOACs) with comparable efficacy and improved safety compared with warfarin alters the balance between risk factors for stroke and benefit of anticoagulation. Our objective was to examine the impact of DOACs as an alternative to warfarin on the net benefit of oral anticoagulant therapy (OAT) in a real-world population of AF patients. Methods Retrospective cohort study of patients with paroxysmal or persistent nonvalvular AF. We updated an Atrial Fibrillation Decision Support Tool (AFDST) to include DOACs as treatment options. The tool generates patient–specific recommendations based upon individual patient risk factor profiles for stroke and major bleeding, using quality-adjusted life years (QALYs) calculated for each treatment strategy by a decision analytic model. The setting included inpatient and ambulatory sites in an academic health center in the mid-western United States. Study involved 5,121 adults with nonvalvular AF seen for any ambulatory visit or inpatient hospitalization over the 1-year period (January through December 2016). Outcome measure was net clinical benefit in QALYs. Results When DOACs are a therapeutic option, the AFDST recommends OAT for 4,134 (81%) patients, and no antithrombotic therapy or aspirin for 489 (9%). A strong recommendation for OAT could not be made in 498 (10%) patients. When warfarin is the only option, OAT is recommended for 3,228 (63%) patients, and no antithrombotic therapy or aspirin for 973 (19%). A strong recommendation for OAT could not be made in 920 (18%) patients. In total, 1,508 QALYs could be gained were treatment changed to that recommended by the AFDST. Conclusions Availability of DOACs increases the proportion of patients for whom oral anticoagulation therapy is recommended in a real-world cohort of AF patients and increased projected QALYs by more than 1,500 when all patients are receiving thromboprophylaxis as recommended by the AFDST compared with current treatment.

Impact of anticoagulation and antiplatelet drugs on surgery rates and mortality in trauma patients

“…About 4% of trauma patients are on anticoagulation therapy (AT) 5 , 6 , mainly due to atrial fibrillation and other cardiovascular diseases (e.g. thromboembolic events, prosthetic heart valves) 7 – 9 . Demographic changes will lead to a further increase in patients on AT 10 , 11 .…”

The Left Atrial Appendage, Including LAA Occlusion Devices Line Watchman, Amulet, and Lariat

“…However, there is an increasing role for the non-vitamin K antagonist oral anticoagulants, also known as direct oral anticoagulants (DOACs), which offer at least equal efficacy in stroke-prevention with a lower risk of bleeding complications. 9,10 Although effective in reducing TE stroke, anticoagulation is associated with major bleeding in up to 5% per year. While DOACs seem to reduce bleeding, [11][12][13] there remains a 2% to 4% annual risk of major hemorrhage.…”