Abstract 231: Outcome Variations Between Patients Prescribed Direct Oral Anticoagulant or Warfarin

Abstract

Background: Patients with cardiovascular disease (CVD) require antithromobotic therapy to reduce risk of embolization. Direct oral anticoagulants (DOAC) were introduced to widespread clinic use in 2010. This study explores differences in demographics and outcomes (readmission, ED visit, death) between patients on a DOAC or warfarin, and the impact of attending a cardiac transitional care appointment (BRIDGE) on outcomes between groups. Methods: Data from patients in the BRIDGE dataset from 2010-2017 were analyzed, excluding those with an adverse event prior to their BRIDGE appointment. Demographics and outcomes of patients prescribed warfarin were compared with those prescribed a DOAC. Outcomes for each group were further compared by BRIDGE clinic attendance. Results: Prescribing of DOACs has linearly increased from 2010-2017. Of 666 anticoagulated patients, 22.5% (n=150) were prescribed a DOAC and 77.5% (n=516) were prescribed warfarin, for any indication. Warfarin patients had higher CHA2DS2-VASc scores and were more likely to visit the ED within 30 days than DOAC patients. DOAC patients were more likely to be readmitted within 6 months. Both warfarin and DOAC patients who attended BRIDGE were less likely to have a readmission within 6 months than patients who did not attend. DOAC patients who attended BRIDGE were also less likely to have an ED visit within 6 months than DOAC patients who did not attend. However, patients with a 30 day adverse event were more likely to have attended BRIDGE (readmission: DOAC 90%, 9/10; warfarin 73.8%, 31/42; ED: DOAC 100%, 5/5; warfarin 78.7, 37/47). Conclusion: Since introduction, DOAC prescription has continuously increased. Warfarin patients had higher CHA2DS2-VASc scores and higher rates of early adverse events (ED visit) than DOAC patients. DOAC patients had higher rates of late adverse events (readmission in 6 months). The differences in early and late readmissions may be partially explained by the necessity of early follow up for those prescribed warfarin at discharge. However, early readmissions overall were more likely to have attended BRIDGE. This suggests that early follow up frequently identifies anticoagulated patients in need of hospitalization, and the importance of prompt transitional care among this population.