Underutilization of anticoagulants in patients with nonvalvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants
Abstract Background Non-vitamin K antagonist oral anticoagulants (NOACs) are preferred over vitamin K antagonists (VKAs) as oral anticoagulant (OAC) therapy in patients with nonvalvular atrial fibrillation (NVAF). This study aimed to estimate the current status and risk factors of OAC underutilizati...
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| Format: | Article |
| Language: | English |
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BMC
2022-01-01
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| Series: | International Journal of Arrhythmia |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42444-021-00053-9 |
| _version_ | 1818953611806244864 |
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| author | Susin Park Nam Kyung Je |
| author_facet | Susin Park Nam Kyung Je |
| author_sort | Susin Park |
| collection | DOAJ |
| description | Abstract Background Non-vitamin K antagonist oral anticoagulants (NOACs) are preferred over vitamin K antagonists (VKAs) as oral anticoagulant (OAC) therapy in patients with nonvalvular atrial fibrillation (NVAF). This study aimed to estimate the current status and risk factors of OAC underutilization in the NOAC era. Method A cross-sectional study using nationwide claims data was conducted. Elderly patients with NVAF at an increased risk of stroke were selected as candidates for OAC therapy before the index date (July 1, 2018). The status of anticoagulant utilization on the index date and factors influencing the use of anticoagulants was investigated in these patients. Results Of the 11,056 patients with NVAF who were eligible for OAC therapy, 7238 (65.5%) were receiving OAC on the index date, and 6302 (87.1%) were receiving NOACs. Patients aged ≥ 75 years had higher anticoagulant utilization than those aged 65–69 years. Among comorbid diseases, while hypertension was the most influential positive factor (odds ratio [OR] = 1.644; confidence interval [CI] = 1.445–1.869) in OAC utilization, severe renal disease was the most influential negative factor (OR = 0.289; CI = 0.200–0.416). Aspirin use had a significantly low OR (OR = 0.097; CI = 0.085–0.110) of anticoagulant use. OAC use was approximately 1.5 times higher in patients with persistent or permanent AF than in those with paroxysmal AF. Conclusion Approximately one-third of patients who are recommended anticoagulation therapy do not take OACs, even though the use of NOACs has become more common. It should be widely recognized that aspirin cannot be an alternative to OACs, and anticoagulant therapy should be actively implemented. |
| first_indexed | 2024-12-20T10:09:02Z |
| format | Article |
| id | doaj.art-f0ee4f6d369145d7afe04cf9074a785f |
| institution | Directory Open Access Journal |
| issn | 2466-1171 |
| language | English |
| last_indexed | 2024-12-20T10:09:02Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Arrhythmia |
| spelling | doaj.art-f0ee4f6d369145d7afe04cf9074a785f2022-12-21T19:44:11ZengBMCInternational Journal of Arrhythmia2466-11712022-01-012311810.1186/s42444-021-00053-9Underutilization of anticoagulants in patients with nonvalvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulantsSusin Park0Nam Kyung Je1College of Pharmacy, Pusan National UniversityCollege of Pharmacy, Pusan National UniversityAbstract Background Non-vitamin K antagonist oral anticoagulants (NOACs) are preferred over vitamin K antagonists (VKAs) as oral anticoagulant (OAC) therapy in patients with nonvalvular atrial fibrillation (NVAF). This study aimed to estimate the current status and risk factors of OAC underutilization in the NOAC era. Method A cross-sectional study using nationwide claims data was conducted. Elderly patients with NVAF at an increased risk of stroke were selected as candidates for OAC therapy before the index date (July 1, 2018). The status of anticoagulant utilization on the index date and factors influencing the use of anticoagulants was investigated in these patients. Results Of the 11,056 patients with NVAF who were eligible for OAC therapy, 7238 (65.5%) were receiving OAC on the index date, and 6302 (87.1%) were receiving NOACs. Patients aged ≥ 75 years had higher anticoagulant utilization than those aged 65–69 years. Among comorbid diseases, while hypertension was the most influential positive factor (odds ratio [OR] = 1.644; confidence interval [CI] = 1.445–1.869) in OAC utilization, severe renal disease was the most influential negative factor (OR = 0.289; CI = 0.200–0.416). Aspirin use had a significantly low OR (OR = 0.097; CI = 0.085–0.110) of anticoagulant use. OAC use was approximately 1.5 times higher in patients with persistent or permanent AF than in those with paroxysmal AF. Conclusion Approximately one-third of patients who are recommended anticoagulation therapy do not take OACs, even though the use of NOACs has become more common. It should be widely recognized that aspirin cannot be an alternative to OACs, and anticoagulant therapy should be actively implemented.https://doi.org/10.1186/s42444-021-00053-9Atrial fibrillationStrokeAnticoagulantsWarfarinNon-vitamin K antagonist oral anticoagulantsUnderutilization |
| spellingShingle | Susin Park Nam Kyung Je Underutilization of anticoagulants in patients with nonvalvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants International Journal of Arrhythmia Atrial fibrillation Stroke Anticoagulants Warfarin Non-vitamin K antagonist oral anticoagulants Underutilization |
| title | Underutilization of anticoagulants in patients with nonvalvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants |
| title_full | Underutilization of anticoagulants in patients with nonvalvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants |
| title_fullStr | Underutilization of anticoagulants in patients with nonvalvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants |
| title_full_unstemmed | Underutilization of anticoagulants in patients with nonvalvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants |
| title_short | Underutilization of anticoagulants in patients with nonvalvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants |
| title_sort | underutilization of anticoagulants in patients with nonvalvular atrial fibrillation in the era of non vitamin k antagonist oral anticoagulants |
| topic | Atrial fibrillation Stroke Anticoagulants Warfarin Non-vitamin K antagonist oral anticoagulants Underutilization |
| url | https://doi.org/10.1186/s42444-021-00053-9 |
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