Skip to main content
SpringerLink
Log in

Utilization of oral anticoagulants in Korean nonvalvular atrial fibrillation patients

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background Although the majority of clinical guidelines indicate the use of NOAC (nonvitamin K antagonist oral anticoagulant) over vitamin K antagonist in nonvalvular atrial fibrillation patients, there is no information on real-world prescription factors that lead to a specific type of oral anticoagulant selection. Objective To evaluate the prescription factors for choosing a specific oral anticoagulant for nonvalvular atrial fibrillation patients in Korea. Setting Nationwide sampled database in South Korea. Methods In this study, we defined nonvalvular atrial fibrillation patients as having one or more hospitalizations or two or more out-patient visits with a stroke risk score (CHA2DS2-VASc scores) ≥ 2 eligible for oral anticoagulant therapy from Jan 1st, 2016 to Dec 31st, 2016. Baseline characteristics were analyzed, including sex, age, comorbidities, CHA2DS2-VASc, bleeding risk score (mHAS-BLED), prescribing specialty, insurance type, medical institution type and location. Univariate and multivariate logistic regression analyses were conducted for being prescribed NOAC compared with vitamin K antagonist. Main outcome measure Adjusted odds ratio of the NOAC group and vitamin K antagonist group. Results Of 9,226 patients eligible for oral anticoagulant therapy, 4999 patients (54.2%) received oral anticoagulant therapy, and 4517 patients took NOAC or vitamin K antagonist only during the study period. Prior stroke, transient ischemic attack, thromboembolism, thyroid disease, dyslipidemia, cancer, mHAS-BLED ≥ 5, in-patient care, and specialty in internal medicine and neurology were positive predictors of NOAC use over vitamin K antagonist, whereas young age (≤64), renal dysfunction, and secondary care institution were negative predictors of NOAC use over vitamin K antagonist. Conclusions The presence of comorbidities was linked to NOAC use over vitamin K antagonist, which is different from prescription factor studies in other countries and requires further study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Korean Statistical Information Service (KOSIS). Annal Report in Korea. Korean Statistical Information Service 2017.

  2. Health Insurance Review and Assessment Service. Healthcare Bigdata Hub. https://opendata.hira.or.kr/op/opc/olapHifrqSickInfo.do. Accessed 1 Mar 2019.

  3. Chiang CE, Okumura K, Zhang S, Chao TF, Siu CW, Wei Lim T, et al. 2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation. J Arrhythm. 2017;33(4):345–67.

    Article  Google Scholar 

  4. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007;146(12):857–67.

    Article  Google Scholar 

  5. Bungard TJ, Ghali WA, Teo KK, McAlister FA, Tsuyuki RT. Why do patients with atrial fibrillation not receive warfarin? Arch Intern Med. 2000;160(1):41–6.

    Article  CAS  Google Scholar 

  6. Lee IH, Kim H, Je NK. Underutilization of warfarin for stroke prophylaxis in patients with atrial fibrillation or atrial flutter in Korea. J Cardiol. 2015;66(6):475–81.

    Article  Google Scholar 

  7. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg. 2016;50(5):e1–e88.

    Article  Google Scholar 

  8. Lee JM, Joung B, Cha M-J, Lee JH, Lim WH, Kim T-H, et al. 2018 KHRS guidelines for stroke prevention therapy in Korean patients with nonvalvular atrial fibrillation. Korean J Med. 2018;93(3):311–2.

    Article  Google Scholar 

  9. Stroke Outcomes Research Working G, Lee JM, Joung B, Cha M-J, Lee JH, Lim WH et al. 2018 KHRS guidelines for stroke prevention therapy in korean patients with nonvalvular atrial fibrillation. Korean J Med. 2018;93(2):87–109.

    Article  Google Scholar 

  10. Ko YJ, Kim S, Park K, Kim M, Yang BR, Kim MS, et al. Impact of the health insurance coverage policy on oral anticoagulant prescription among patients with atrial fibrillation in Korea from 2014 to 2016. J Korean Med Sci. 2018;33(23):e163.

    Article  Google Scholar 

  11. Lee SR, Choi EK, Han KD, Cha MJ, Oh S. Trends in the incidence and prevalence of atrial fibrillation and estimated thromboembolic risk using the CHA2DS2-VASc score in the entire Korean population. Int J Cardiol. 2017;236:226–31.

    Article  Google Scholar 

  12. Gundlund A, Staerk L, Fosbol EL, Gadsboll K, Sindet-Pedersen C, Bonde AN, et al. Initiation of anticoagulation in atrial fibrillation: which factors are associated with choice of anticoagulant? J Intern Med. 2017;282(2):164–74.

    Article  CAS  Google Scholar 

  13. Ono F, Tanaka S, Nakao YM, Kawakami K. Utilization of anticoagulant and antiplatelet agents among patients with atrial fibrillation undergoing percutaneous coronary intervention-retrospective cohort study using a nationwide claims database in Japan. Circ J. 2018;82(2):361–8.

    Article  Google Scholar 

  14. Savarese G, Sartipy U, Friberg L, Dahlström U, Lund LH. Reasons for and consequences of oral anticoagulant underuse in atrial fibrillation with heart failure. Heart. 2018;104(13):1093–100.

    Article  CAS  Google Scholar 

  15. Kim L, Kim J-A, Kim S. A guide for the utilization of health insurance review and assessment service national patient samples. Epidemiol Health. 2014;36:e2014008.

    Article  Google Scholar 

  16. Aljunid SM, Srithamrongsawat S, Chen W, Bae SJ, Pwu R-F, Ikeda S et al. Health-care data collecting, sharing, and using in Thailand, China Mainland, South Korea, Taiwan, Japan, and Malaysia. Value Health. 2012;15(1, Supplement):S132–8. https://doi.org/10.1016/j.jval.2011.11.004.

    Article  PubMed  Google Scholar 

  17. Gage BF, van Walraven C, Pearce L, Hart RG, Koudstaal PJ, Boode BS, et al. Selecting patients with atrial fibrillation for anticoagulation: stroke risk stratification in patients taking aspirin. Circulation. 2004;110(16):2287–92.

    Article  CAS  Google Scholar 

  18. Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest. 2010;137(2):263–72.

    Article  Google Scholar 

  19. Kang SH, Choi EK, Han KD, Lee SR, Lim WH, Cha MJ, et al. Risk of ischemic stroke in patients with non-valvular atrial fibrillation not receiving oral anticoagulants-Korean Nationwide Population-Based Study. Circ J. 2017;81(8):1158–64.

    Article  Google Scholar 

  20. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. 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. 2010;138(5):1093–100.

    Article  Google Scholar 

  21. Yoon CY, Noh J, Jhee JH, Chang TI, Kang EW, Kee YK, et al. Warfarin use in patients with atrial fibrillation undergoing hemodialysis: a nationwide population-based study. Stroke. 2017;48(9):2472–9.

    Article  CAS  Google Scholar 

  22. Park SY, Bae S, Shin JY. Real-world prescribing patterns of long-acting benzodiazepines for elderly Koreans in 2013. Int J Clin Pharmacol Ther. 2017;55(6):472–9.

    Article  Google Scholar 

  23. Maura G, Billionnet C, Drouin J, Weill A, Neumann A, Pariente A. Oral anticoagulation therapy use in patients with atrial fibrillation after the introduction of non-vitamin K antagonist oral anticoagulants: findings from the French healthcare databases, 2011–2016. BMJ Open. 2019;9(4):e026645.

    Article  Google Scholar 

  24. Sindet-Pedersen C, Pallisgaard JL, Staerk L, Berger JS, Lamberts M, Torp-Pedersen C, et al. Temporal trends in initiation of VKA, rivaroxaban, apixaban and dabigatran for the treatment of venous thromboembolism—a Danish nationwide cohort study. Sci Rep. 2017;7(1):3347.

    Article  Google Scholar 

  25. Rodriguez-Bernal CL, Hurtado I, Garcia-Sempere A, Peiro S, Sanfelix-Gimeno G. Oral anticoagulants initiation in patients with atrial fibrillation: real-world data from a population-based cohort. Front Pharmacol. 2017;8:63.

    Article  Google Scholar 

  26. Chiang CE, Wang KL, Lip GY. Stroke prevention in atrial fibrillation: an Asian perspective. Thromb Haemost. 2014;111(5):789–97.

    Article  CAS  Google Scholar 

  27. Choi S. Diffusion of innovation: a study on the adoption of new drugs in Korea: Seoul National University 2004.

  28. Huiart L, Ferdynus C, Renoux C, Beaugrand A, Lafarge S, Bruneau L, et al. Trends in initiation of direct oral anticoagulant therapies for atrial fibrillation in a national population-based cross-sectional study in the French health insurance databases. BMJ Open. 2018;8(3):e018180.

    Article  Google Scholar 

  29. Blech S, Ebner T, Ludwig-Schwellinger E, Stangier J, Roth W. The metabolism and disposition of the oral direct thrombin inhibitor, dabigatran, in humans. Drug Metab Dispos. 2008;36(2):386–99.

    Article  CAS  Google Scholar 

  30. Turpie AG. Oral, direct factor Xa inhibitors in development for the prevention and treatment of thromboembolic diseases. Arterioscler Thromb Vasc Biol. 2007;27(6):1238–47.

    Article  CAS  Google Scholar 

  31. Vedovati MC, Germini F, Agnelli G, Becattini C. Direct oral anticoagulants in patients with VTE and cancer: a systematic review and meta-analysis. Chest. 2015;147(2):475–83.

    Article  Google Scholar 

  32. van Es N, Coppens M, Schulman S, Middeldorp S, Buller HR. Direct oral anticoagulants compared with vitamin K antagonists for acute venous thromboembolism: evidence from phase 3 trials. Blood. 2014;124(12):1968–75.

    Article  Google Scholar 

  33. Lee SR, Choi EK, Han KD, Cha MJ, Oh S, Lip GYH. Temporal trends of antithrombotic therapy for stroke prevention in Korean patients with non-valvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants: A nationwide population-based study. PLoS ONE. 2017;12(12):e0189495.

    Article  Google Scholar 

Download references

Acknowledgements

The authors are grateful to Ms., Juhee Han for her generous support.

Funding

None.

Author information

Authors and Affiliations

  1. College of Pharmacy, Ewha Womans University, Seoul, 03760, Republic of Korea

    Hye-Yoon Song, Kyung-Bok Son & SeungJin Bae

  2. School of Pharmacy, Sungkyunkwan University, Suwon, 16419, Republic of Korea

    Ju-Young Shin

Authors
  1. Hye-Yoon Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kyung-Bok Son
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ju-Young Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. SeungJin Bae
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to SeungJin Bae.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 31 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Song, HY., Son, KB., Shin, JY. et al. Utilization of oral anticoagulants in Korean nonvalvular atrial fibrillation patients. Int J Clin Pharm 41, 1434–1441 (2019). https://doi.org/10.1007/s11096-019-00901-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-019-00901-8

Keywords

Search

Navigation