NOACs Now Mainstream for the Use of Anticoagulation in Non-Valvular Atrial Fibrillation in Australia

Pol, D.; Curtis, Claire; Ramkumar, S.; Bittinger, L.

doi:10.1016/j.hlc.2018.03.010

Cited by 14 publications

(10 citation statements)

References 4 publications

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“…In Australia and elsewhere, DOAC dispensing has increased concomitantly with decreasing warfarin, although warfarin remains commonly prescribed [44,[47][48][49][50][51][52][53][54][55], and recent surveys show that warfarin is favoured amongst a significant proportion of clinicians [56], particularly for patients in whom use is established. In Australia, reports indicate that around one-quarter to one-third of initial anticoagulant prescribing is for warfarin [48,49,54]. There is also growing evidence that DOAC prescribing behaviour is influenced by the same perceived barriers that limited the wider use of warfarin indicating that DOACs do not appear to have bridged the evidence-practice gap as initially hoped and are subject to the same perceived limitations of warfarin.…”

Section: Implications For Current Practicementioning

confidence: 99%

Supporting anticoagulant treatment decision making to optimise stroke prevention in complex patients with atrial fibrillation: a cluster randomised trial

et al. 2020

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Background: Anticoagulation for preventing stroke in atrial fibrillation is under-utilised despite evidence supporting its use, resulting in avoidable death and disability. We aimed to evaluate an intervention to improve the uptake of anticoagulation. Methods: We carried out a national, cluster randomised controlled trial in the Australian primary health care setting. General practitioners received an educational session, delivered via telephone by a medical peer and provided information about their patients selected either because they were not receiving anticoagulation or for whom anticoagulation was considered challenging. General practitioners were randomised to receive feedback from a medical specialist about the cases (expert decisional support) either before or after completing a post-test audit. The primary outcome was the proportion of patients reported as receiving oral anticoagulation. A secondary outcome assessed antithrombotic treatment as appropriate against guideline recommendations. Results: One hundred and seventy-nine general practitioners participated in the trial, contributing information about 590 cases. At post-test, 152 general practitioners (84.9%) completed data collection on 497 cases (84.2%). A 4.6% (Adjusted Relative Risk = 1.11, 95% CI = 0.86-1.43) difference in the post-test utilization of anticoagulation between groups was not statistically significant (p = 0.42). Sixty-one percent of patients in both groups received appropriate antithrombotic management according to evidence-based guidelines at post-test (Adjusted Relative Risk = 1.0; 95% CI = 0.85 to 1.19) (p = 0.97). Conclusions: Specialist feedback in addition to an educational session did not increase the uptake of anticoagulation in patients with AF. Trial registration: ANZCTRN12611000076976 Retrospectively registered.

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Section: Implications For Current Practicementioning

confidence: 99%

Supporting anticoagulant treatment decision making to optimise stroke prevention in complex patients with atrial fibrillation: a cluster randomised trial

et al. 2020

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“…Traditionally, Warfarin stood the merely available anticoagulants. [ 6,7 ] Many studies have reported the widespread use of direct oral anticoagulants (DOACs) like Apixaban is growing worldwide, while the Warfarin use has revealed a continual and adamant drop. [ 8,9 ] Following the previous readings, the Saudi clinical practice Guidelines prefer the usage of novel anticoagulants as an alternative to the dual therapy of parenteral anticoagulants with vitamin K antagonists.…”

Section: Introductionmentioning

confidence: 99%

Anticoagulant drug utilization pattern and their cost analysis: a retrospective study from Saudi Arabia

Ali¹,

Ahmad²,

Banu³

et al. 2020

Journal of Pharmaceutical Health Services Research

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Objective The study was aimed to evaluate the cost and drug utilization pattern of anticoagulant drugs in a clinical setting in Saudi Arabia. Method A cross‐sectional retrospective study was conducted in a private hospital in Saudi Arabia. World Health Organization, defined daily dose, and American Society of Hematology methods were used to compute the daily price of each anticoagulant agent. Key findings Consumption of oral anticoagulants was very less as compared to the parenteral. Apixaban was the most prescribed oral drug, while enoxaparin sodium was the drug of choice among the parenteral. In oral anticoagulants, the unit‐wise cost was found to be highest for Rivaroxaban (12.60 SR (3.36 USD) and less for Warfarin (0.82 SR (0.22 USD)). Heparin sodium cost (51.62 SR (13.76 USD) was found to be the most expensive parenteral agent while the least expensive was Phytomenadione (3.76 SR (1.00 USD)). Conclusion Apixaban was the preferred oral anticoagulant among all the studied anticoagulants, although Warfarin is the cheapest. Therapeutic drug monitoring was recommended for Warfarin. The study highlights the importance of more studies to measure the advantages and disadvantages of all types of anticoagulants.

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“…While the vitamin K antagonist warfarin has been the mainstay of stroke prevention for decades, its use is declining in favour of non-vitamin K oral anticoagulants (NOACs). A recent count of prescriptions filled under the Australian Pharmaceutical Benefits Scheme (PBS) for those eligible through the Department of Veteran's Affairs reported that NOACs were 67% of anticoagulants supplied for AF by mid-2017 [3] . Similar trends are reported from population studies in other countries [4][5][6] .…”

Section: Introductionmentioning

confidence: 99%

Warfarin Use and Mortality, Stroke, and Bleeding Outcomes in a Cohort of Elderly Patients with non-Valvular Atrial Fibrillation

J¹,

Hung²,

Knuiman³

et al. 2019

Journal of Atrial Fibrillation

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Aims : To determine exposure to warfarin and the associated outcomes in a population of older patients with non-valvular atrial fibrillation (NVAF). Methods : Cohort study of patients aged 65-89 years admitted to hospital July 2003-December 2008 with newly-diagnosed or pre-existing AF. Outcomes at three years among one-year survivors post-index admission (landmark date) were all-cause mortality, stroke/systemic thromboembolism (stroke/TE) and bleeding. Multivariate Cox models were used to identify factors associated with each outcome. Results : AF was the principal diagnosis for 27.5% of 17,336 index AF admissions. Of 14,634 (84.4%) patients alive at one-year 1,384 (9.5%) died in the following year. Vascular disease (42%) was the most frequent cause of death. Warfarin use, prior to the index admission and/or the 1-year landmark, did not exceed 40%. Compared to non-exposure or discontinuation at the index admission, initiation or persistence with warfarin prior to the landmark date was associated with reduced risk for all-cause mortality, a statistically non-significant reduction in risk for stroke/TE, and an increased risk for bleeding. Higher CHA2DS2-VASc scores were associated with increased risk for each outcome. Conclusions : In a population-based cohort of hospitalised NVAF patients, the initiation and persistent use of warfarin was associated with lower all-cause mortality risk to three years, although reduction in risk for stroke/TE did not reach statistical significance. The apparent under-use of warfarin in this older, high-risk cohort reinforces the opportunity for further reduction in stroke/TE with the uptake of nonvitamin K oral anti-coagulants (NOACs) among those not prescribed, or not persistent with, warfarin.

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NOACs Now Mainstream for the Use of Anticoagulation in Non-Valvular Atrial Fibrillation in Australia

Cited by 14 publications

References 4 publications

Supporting anticoagulant treatment decision making to optimise stroke prevention in complex patients with atrial fibrillation: a cluster randomised trial

Supporting anticoagulant treatment decision making to optimise stroke prevention in complex patients with atrial fibrillation: a cluster randomised trial

Anticoagulant drug utilization pattern and their cost analysis: a retrospective study from Saudi Arabia

Warfarin Use and Mortality, Stroke, and Bleeding Outcomes in a Cohort of Elderly Patients with non-Valvular Atrial Fibrillation

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