Abstract 9312: Factors That Predict the Choice of Oral Anticoagulants in Men and Women With Atrial Fibrillation

Abstract

Introduction: Potential sex-specific differences in oral anticoagulation (OAC) initiation among atrial fibrillation (AF) patients discharged from hospital into the community have not previously been investigated. This study identified sex-specific factors associated with OAC initiation in patients with AF. Methods: Using hospitalization and drug databases, we built a cohort of AF patients having been hospitalized and then discharged to the community between 2014 and 2017 in Québec, Canada. The primary outcome was the choice of OAC (warfarin, high-dose or low-dose DOAC) initiated upon hospital discharge, based on the first claim at the index date. Multivariate logistic regression was used to identify predictors of low-dose and standard-dose DOAC vs warfarin initiation, and low-dose vs standard-dose DOACs initiation. Results: 32,050 patients were included, from whom 16,896 (53%) were women. In both sexes, warfarin initiation decreased while DOACs initiation increased over time. 17.3%, 29.0% and 53.7% of women were started on warfarin, low-dose and standard-dose DOACs, respectively while 15.6%, 16.6% and 67.8% of men were started on warfarin, low-dose and standard-dose DOACs, respectively. Year of initiation was a predictor of DOACs (odds ratios (ORs): from 1.40 to 8.37) (vs warfarin initiation in both sex (Table 1). Older age predicted the use of low-dose DOACs vs warfarin in both sex (ORs: from 1.65 to 3.99 age 65-79 and from 1.83 to 10.29 in age ≥80), while a CHA 2 DS 2 -VASc score ≥3 predicted the use of low-dose DOACs in women only (ORs from 1.98 to 2.49). Age ≥80 (ORs: from 17.99 to 64.82) and chronic kidney disease (CKD) (ORs from 2.82 to 7.42) predicted the use of low-dose DOACs vs standard DOACs in both sex (ORs: from 2.64 to 3.29 age. Conclusions: Women were more likely than men to received low-dose DOACs and the decision to initiate low- vs standard-dose DOACs was mainly driven by age, CKD status (in both sexes) and a high CHA 2 DS 2 -VASc score (in women only).