Abstract 17373: Prescription Patterns and Outcomes of Direct Oral Anticoagulants and Warfarin in Patients With Atrial Fibrillation a Real World Analysis

Abstract

Introduction: Direct Oral Anticoagulants (DOACs) are used for stroke prevention in Atrial Fibrillation (AF). Hypothesis: We sought to evaluate differences in prescription patterns of DOACs and warfarin in new onset AF patients in relation to CHA2DS2Vasc score and compare outcomes of ischemic stroke, gastrointestinal (GI) bleed and intracranial hemorrhage (ICH) between DOACs and warfarin. Methods: All patients with a new diagnosis of AF from 2014 to 2017 were identified from the admission database at the University of Arkansas for Medical Sciences, AR, U.S.A. Trends in anticoagulant prescription were plotted in relation to CHA2DS2Vasc score. Baseline characteristics were compared using t-test and chi-square test as appropriate. Multivariate logistic regression was used to identify independent predictors of clinical outcomes of interest. Results: We examined a total of 2362 patients (1306 on warfarin and 1056 on DOACs). Prescription rates of warfarin increased with increasing CHA2DS2Vasc (Fig 1). Patients on warfarin had a higher prevalence of hypertension, diabetes, heart failure, renal failure and liver disease (Table 1a). On multivariate analysis, there was no difference in the incidence of ischemic stroke and GI bleeding between warfarin and DOACs (Table 1b). However, there was a trend towards lower incidence of ICH in DOAC group (p=0.06), despite wider usage in patients with higher CHA2DS2Vasc score. Conclusions: In a real-world setting, the use of DOACs was lower in patients with high CHA2DS2Vasc score compared with warfarin. Trend towards lower incidence of ICH was present in DOAC group. Further larger studies assessing safety of DOACs in patients with high CHA2DS2Vasc are needed.