Main Article Content
Atrial fibrillation, anticoagulants, warfarin, novel anticoagulants, apixaban, dabigatran, rivaroxaban
Novel oral anticoagulants are available for the management of atrial fibrillation and are considered more convenient to use than warfarin.
The main objective of this study was to describe patterns of oral anticoagulant use in the 6 months period following the availability of dabigatran at our hospital.
A cross-sectional study was conducted in a single university hospital in the province of Québec, Canada. Medical records of subjects on oral anticoagulants for atrial fibrillation that were hospitalized between October 1 st, 2011 and March 31th, 2012 were reviewed. Type of use (prevalent, incident and switch) and patient’s characteristics of warfarin and dabigatran users were compared using Chi-squared and T-tests.
In the 6 -month period following dabigatran availability in the hospital, 59 patients (13%) were on dabigatran and 388 (87%) on warfarin. Mean CHADS 2 score, mean age and mean number of chronic medications were lower in the dabigatran group. The percentage of patients with coronary artery disease was lower and renal function was higher in the dabigatran group.
Dabigatran use remained low in the first 6 months period following the approval of dabigatran at our hospital, which could be explained by limited data on the efficacy and safety of this agent in subjects with multiple comorbidities.
2. Cairns JA, Connolly S, McMurtry S, Stephenson M, Talajic M. Canadian Cardiovascular Society Atrial Fibrillation Guidelines 2010: Prevention of stroke and s ystemic thromboembolism in a trial fibrillation and f lutter. Can J Cardiol 2011;27:74- 90.
3. Hart RG, Pearce LA, Aguilar MI. Meta -analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation . Ann Intern Med 2007;146:857- 67.
4. Wisler JW, Becker RC. A guidance pathway for the selection of novel anticoagulants in the treatment of atrial fibrillation. Crit Pathw Cardiol 2012;11:55- 61.
5. Hickey K. Anticoagulation management in clinical practice: preventing stroke in patients with atrial fibrillation. Heart Lung 2012;41:146- 56.
6. Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009;361:1139- 51.
7. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011;365:883- 91.
8. Granger CB, Alexander J H, McMurray JJV, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011;365:981- 92.
9. Giugliano RP, Ruff CT, Braunwald E, et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2013;369:2093- 104.
10. Skanes AC, Healey JS, Cairns JA, et al. F ocused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines: recommendations for stroke prevention and rate/rhythm control . Can J of Cardiol 2012;28:125- 36.
11. Sørensen R, Gislason G, Torp -Pedersen C, et al. Dabigatran use in Danish atrial fibrillation patients in 2011: a nationwide study. BMJ open 2013;3: e002758.
12. Larsen TB, Rasmussen LH, Skjoth F, et al. Efficacy and safety of dabigatran etexilate and warfarin in "real -world" patients with atrial fibrillation: a prospective nationwide cohort study. J Am Coll Cardiol 2013;61:2264- 73.
13. Institut national d'excellence en santé et en services sociaux (INESSS). Portrait de l’usage du dabigatran chez les personnes assurées par le régime public d’assurance médicaments. Available at : http://www.inesss.qc.ca/fileadmin/doc/INESSS/R apports/Medicaments/INESSS_Portraitdusage_D abigatran.pdf Accessed December 30, 2013.
14. Olsson SB. Stroke prevention with the oral direct thrombin inhibitor ximelagatran compared with warfarin in patients with non -valvular atrial fibrillation (SPORTIF III): randomised controlled trial. Lancet 2003;362:1691- 8.