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Prescription patterns of oral anticoagulants for patients with non-valvular atrial fibrillation: experience at a Japanese single institution

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Abstract

New oral anticoagulants (NOACs) are now clinically available. However, few studies have demonstrated which patients with non-valvular atrial fibrillation (NVAF) actually receive NOACs in a clinical setting. We analyzed 182 NVAF patients who received oral anticoagulants. Clinical backgrounds and the risk of stroke, systemic embolism, and bleeding associated with oral anticoagulants were investigated. Seventy-three (40 %) patients were treated with NOACs and 109 (60 %) patients were treated with warfarin. A significantly lower mean number of bleeding risk factors was observed among the patients treated with NOACs than among those treated with warfarin (P = 0.010). Of the bleeding risk factors, NOACs were significantly less frequently prescribed in patients with a bleeding history and elderly subjects (>65 years) than in those who received warfarin (P < 0.001 and P = 0.029). A multivariate logistic regression analysis revealed that CHF and bleeding history were independently and significantly associated with the administration of NOACs (P = 0.047 and P = 0.003). The rate of a history of intracranial hemorrhage was comparable between the patients treated with NOACs and those treated with warfarin (P = 1.000). Significantly lower rates of a history of gastrointestinal and other minor bleeding were observed in the patients who received NOACs versus those who received warfarin (P = 0.001 and P = 0.026). NOACs were less frequently prescribed in patients with a history of bleeding, especially those with a history of gastrointestinal bleeding in a clinical setting.

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References

  1. Wolf PA, Abbott RD, Kannel WB (1991) Atrial fibrillation as an independent risk factor for stroke: the framingham study. Stroke 22:983–988

    Article  CAS  PubMed  Google Scholar 

  2. Hylek EM, Go AS, Chang Y, Jensvold NG, Henault LE, Selby JV, Singer DE (2003) Effect of intensity of oral anticoagulation on stroke severity and mortality in atrial fibrillation. N Engl J Med 349:1019–1026

    Article  CAS  PubMed  Google Scholar 

  3. Kishima H, Mine T, Kodani T, Masuyama T (2014) Prediction of left atrial thrombi in patients with atrial tachyarrhythmias during warfarin administration: retrospective study in hyogo college of medicine. Heart Vessels. doi:10.1007/s00380-014-0496-5

    Google Scholar 

  4. Hart RG, Pearce LA, Aguilar MI (2007) Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 146:857–867

    Article  PubMed  Google Scholar 

  5. JCS Joint Working Group (2014) Guidelines for pharmacotherapy of atrial fibrillation (jcs 2013). Circ J 78:1997–2021

    Article  Google Scholar 

  6. Gomez-Outes A, Suarez-Gea ML, Calvo-Rojas G, Lecumberri R, Rocha E, Pozo-Hernandez C, Terleira-Fernandez AI, Vargas-Castrillon E (2012) Discovery of anticoagulant drugs: a historical perspective. Curr Drug Discov Technol 9:83–104

    Article  CAS  PubMed  Google Scholar 

  7. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, Pogue J, Reilly PA, Themeles E, Varrone J, Wang S, Alings M, Xavier D, Zhu J, Diaz R, Lewis BS, Darius H, Diener HC, Joyner CD, Wallentin L, Committee R-LS, Investigators (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361:1139–1151

    Article  CAS  PubMed  Google Scholar 

  8. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, Breithardt G, Halperin JL, Hankey GJ, Piccini JP, Becker RC, Nessel CC, Paolini JF, Berkowitz SD, Fox KA, Califf RM, Investigators RA (2011) Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 365:883–891

    Article  CAS  PubMed  Google Scholar 

  9. Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A, Bahit MC, Diaz R, Easton JD, Ezekowitz JA, Flaker G, Garcia D, Geraldes M, Gersh BJ, Golitsyn S, Goto S, Hermosillo AG, Hohnloser SH, Horowitz J, Mohan P, Jansky P, Lewis BS, Lopez-Sendon JL, Pais P, Parkhomenko A, Verheugt FW, Zhu J, Wallentin L, Committees A, Investigators (2011) Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 365:981–992

    Article  CAS  PubMed  Google Scholar 

  10. Hori M, Matsumoto M, Tanahashi N, Momomura S, Uchiyama S, Goto S, Izumi T, Koretsune Y, Kajikawa M, Kato M, Ueda H, Iwamoto K, Tajiri M, Investigators JRAs (2012) Rivaroxaban vs. warfarin in japanese patients with atrial fibrillation—the J-ROCKET AF study. Circ J 76:2104–2111

    Article  CAS  PubMed  Google Scholar 

  11. Giugliano RP, Ruff CT, Braunwald E, Murphy SA, Wiviott SD, Halperin JL, Waldo AL, Ezekowitz MD, Weitz JI, Spinar J, Ruzyllo W, Ruda M, Koretsune Y, Betcher J, Shi M, Grip LT, Patel SP, Patel I, Hanyok JJ, Mercuri M, Antman EM, Investigators EA-T (2013) Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 369:2093–2104

    Article  CAS  PubMed  Google Scholar 

  12. Dentali F, Riva N, Crowther M, Turpie AG, Lip GY, Ageno W (2012) Efficacy and safety of the novel oral anticoagulants in atrial fibrillation: a systematic review and meta-analysis of the literature. Circulation 126:2381–2391

    Article  CAS  PubMed  Google Scholar 

  13. Lip GY, Larsen TB, Skjoth F, Rasmussen LH (2012) Indirect comparisons of new oral anticoagulant drugs for efficacy and safety when used for stroke prevention in atrial fibrillation. J Am Coll Cardiol 60:738–746

    Article  CAS  PubMed  Google Scholar 

  14. Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, Camm AJ, Weitz JI, Lewis BS, Parkhomenko A, Yamashita T, Antman EM (2014) Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 383:955–962

    Article  CAS  PubMed  Google Scholar 

  15. Walenga JM, Adiguzel C (2010) Drug and dietary interactions of the new and emerging oral anticoagulants. Int J Clin Pract 64:956–967

    Article  CAS  PubMed  Google Scholar 

  16. Larsen TB, Rasmussen LH, Skjoth F, Due KM, Callreus T, Rosenzweig M, Lip GY (2013) Efficacy and safety of dabigatran etexilate and warfarin in “real-world” patients with atrial fibrillation: a prospective nationwide cohort study. J Am Coll Cardiol 61:2264–2273

    Article  CAS  PubMed  Google Scholar 

  17. Lip GY, Laroche C, Dan GA, Santini M, Kalarus Z, Rasmussen LH, Ioachim PM, Tica O, Boriani G, Cimaglia P, Diemberger I, Hellum CF, Mortensen B, Maggioni AP (2014) ‘Real-world’ antithrombotic treatment in atrial fibrillation: the EORP-AF pilot survey. Am J Med 127:519–529

    Article  PubMed  Google Scholar 

  18. Sorensen R, Gislason G, Torp-Pedersen C, Olesen JB, Fosbol EL, Hvidtfeldt MW, Karasoy D, Lamberts M, Charlot M, Kober L, Weeke P, Lip GY, Hansen ML (2013) Dabigatran use in danish atrial fibrillation patients in 2011: a nationwide study. BMJ Open. doi:10.1136/bmjopen-2013-002758

    Google Scholar 

  19. Desai NR, Krumme AA, Schneeweiss S, Shrank WH, Brill G, Pezalla EJ, Spettell CM, Brennan TA, Matlin OS, Avorn J, Choudhry NK (2014) Patterns of initiation of oral anticoagulants in patients with atrial fibrillation- quality and cost implications. Am J Med 127:1075–1082

    Article  PubMed  Google Scholar 

  20. Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41

    Article  CAS  PubMed  Google Scholar 

  21. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ (2001) Validation of clinical classification schemes for predicting stroke: results from the national registry of atrial fibrillation. JAMA 285:2864–2870

    Article  CAS  PubMed  Google Scholar 

  22. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY (2010) A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the euro heart survey. Chest 138:1093–1100

    Article  PubMed  Google Scholar 

  23. European Heart Rhythm A, European Association for Cardio-Thoracic S, Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH (2010) Guidelines for the management of atrial fibrillation: The task force for the management of atrial fibrillation of the european society of cardiology (esc). Eur Heart J 31:2369–2429

  24. Inoue H, Nozawa T, Hirai T, Iwasa A, Okumura K, Lee JD, Shimizu A, Hayano M, Yano K (2006) Accumulation of risk factors increases risk of thromboembolic events in patients with nonvalvular atrial fibrillation. Circ J 70:651–656

    Article  CAS  PubMed  Google Scholar 

  25. Hurlen M, Abdelnoor M, Smith P, Erikssen J, Arnesen H (2002) Warfarin, aspirin, or both after myocardial infarction. N Engl J Med 347:969–974

    Article  CAS  PubMed  Google Scholar 

  26. JCS Joint Working Group (2013) Guidelines for secondary prevention of myocardial infarction (jcs 2011). Circ J 77:231–248

    Article  Google Scholar 

  27. Suh SY, Kang WC, Oh PC, Choi H, Moon CI, Lee K, Han SH, Ahn T, Choi IS, Shin EK (2014) Efficacy and safety of aspirin, clopidogrel, and warfarin after coronary artery stenting in korean patients with atrial fibrillation. Heart Vessels 29:578–583

    Article  PubMed  Google Scholar 

  28. Lamberts M, Gislason GH, Lip GY, Lassen JF, Olesen JB, Mikkelsen AP, Sorensen R, Kober L, Torp-Pedersen C, Hansen ML (2014) Antiplatelet therapy for stable coronary artery disease in atrial fibrillation patients taking an oral anticoagulant: a nationwide cohort study. Circulation 129:1577–1585

    Article  CAS  PubMed  Google Scholar 

  29. Oldgren J, Wallentin L, Alexander JH, James S, Jonelid B, Steg G, Sundstrom J (2013) New oral anticoagulants in addition to single or dual antiplatelet therapy after an acute coronary syndrome: a systematic review and meta-analysis. Eur Heart J 34:1670–1680

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Douxfils J, Buckinx F, Mullier F, Minet V, Rabenda V, Reginster JY, Hainaut P, Bruyere O, Dogne JM (2014) Dabigatran etexilate and risk of myocardial infarction, other cardiovascular events, major bleeding, and all-cause mortality: a systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. doi:10.1161/JAHA.113.000515

    PubMed  PubMed Central  Google Scholar 

  31. Loke YK, Pradhan S, Yeong JK, Kwok CS (2014) Comparative coronary risks of apixaban, rivaroxaban and dabigatran: a meta-analysis and adjusted indirect comparison. Br J Clin Pharmacol 78:707–717

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Pradaxa (dabigatran etexilate mesylate): Drug safety communication—safety review of post-market reports of serious bleeding events; 2011. http://www.fda.gov/safety/medwatch/safetyinformation/safetyalertsforhumanmedicalproducts/ucm282820.htm

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Acknowledgments

This work was supported by JSPS KAKENHI Grant No. 25461075 (H.I).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Cardiology, Fujita Health University Banbuntane Hotokukai Hospital, 3-6-10, Otobashi, Nakagawa-ku, Nagoya, 454-0012, Japan

    Manaka Tagaya, Daiji Yoshikawa, Yoshinori Sugishita, Takehiro Ito, Tomohito Kamada, Masataka Yoshinaga, Daisuke Mukaide, Wakaya Fujiwara, Hiroatsu Yokoi, Mutsuharu Hayashi & Hideo Izawa

  2. Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Daiji Yoshikawa & Mutsuharu Hayashi

  3. Hospital Pharmacy, Fujita Health University Banbuntane Hotokukai Hospital, Nagoya, Japan

    Fumi Yamauchi

  4. Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan

    Eiichi Watanabe, Junichi Ishii & Yukio Ozaki

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  1. Manaka Tagaya
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  2. Daiji Yoshikawa
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  3. Yoshinori Sugishita
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Correspondence to Daiji Yoshikawa.

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Tagaya, M., Yoshikawa, D., Sugishita, Y. et al. Prescription patterns of oral anticoagulants for patients with non-valvular atrial fibrillation: experience at a Japanese single institution. Heart Vessels 31, 957–962 (2016). https://doi.org/10.1007/s00380-015-0694-9

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  • DOI: https://doi.org/10.1007/s00380-015-0694-9

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