Abstract
BackgroundFollowing their introduction, the non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly prescribed in Asia for stroke prevention in patients with non-valvular atrial fibrillation (AF). Few contemporary data are available on temporal trends in antithrombotic therapy use in Asian countries, in the era of NOACs.Methods and resultsUsing the National Health Insurance Service database of the entire Korean adult AF population, the use of aspirin, vitamin K antagonist, and NOACs between 2008 and 2015 were analyzed (n = 276,246 in 2015). Most of the included cohort had CHA2DS2-VASc score ≥ 2 (78.2% in 2008 and 83.2% in 2015), yet approximately 17% were prescribed no antithrombotic therapy throughout the study period. Aspirin prescription consistently decreased (from 48.2% to 31.5%) over time, while OAC prescription significantly increased from 34.7% to 50.6%. NOAC prescriptions accounted for 50% of total OAC prescription in 2015. Similar trends in antithrombotic therapy were found both in men and in women, but women were more likely to be undertreated with OAC. Female gender, presence of vascular disease and prior intracranial hemorrhage were associated with OAC underuse.ConclusionsBetween 2008 and 2015, a greater proportion of AF patients received OAC treatment with increasing NOAC prescription trends in the recent 3 years. A substantial proportion (approx. 50%) of Korean patients with AF still remain undertreated.
Highlights
Atrial fibrillation (AF) is associated with an up to 5-fold increase in the risk of stroke, and stroke prevention is fundamental in the management of patients with atrial fibrillation (AF) [1]
We reviewed the inpatient and outpatient prescription records of each patient to determine if there was any prescription of antithrombotic therapy including aspirin, vitamin K antagonists (VKAs), and non-vitamin K antagonist oral anticoagulants (NOACs)
The proportion of patients with AF who were strongly recommended for oral anticoagulants (OACs) treatment for stroke prevention has increased throughout the study period (p for trend < 0.001) [6]
Summary
Atrial fibrillation (AF) is associated with an up to 5-fold increase in the risk of stroke, and stroke prevention is fundamental in the management of patients with AF [1]. Changes in treatment guidelines promoting NOAC use and discouraging aspirin have increased focus on OAC use for stroke prevention in AF [7,10,11] Despite these major changes in stroke prevention in AF, few contemporary data are available about the changes of antithrombotic prescribing patterns, especially in the Asian population [12,13,14]. Following their introduction, the non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly prescribed in Asia for stroke prevention in patients with non-valvular atrial fibrillation (AF). Few contemporary data are available on temporal trends in antithrombotic therapy use in Asian countries, in the era of NOACs
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