Uptake of Oral Anticoagulants for Stroke Prevention in Patients with Atrial Fibrillation in a Single Clinical Commissioning Group in England Without Restrictions to Their Use

Background and Objective In England, the uptake of direct oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation has been slow and varied across different Clinical Commissioning Groups (CCGs). This study aimed to profile the prescribing of oral anticoagulants for stroke prevention...

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Bibliographic Details
Published in:Clinical drug investigation Vol. 39; no. 4; pp. 401 - 405
Main Authors: Medlinskiene, Kristina, Fay, Matthew, Petty, Duncan
Format: Journal Article
Language:English
Published: Cham Springer International Publishing 01.04.2019
Springer Nature B.V
Subjects:
Age
Anticoagulants
Aspirin
Cardiac arrhythmia
Family physicians
Heart
Internal Medicine
Medicine
Medicine & Public Health
Patients
Pharmacology/Toxicology
Pharmacotherapy
Prevention
Short Communication
Stroke
Studies
Thrombosis
Trends
ISSN:1173-2563, 1179-1918, 1179-1918
Online Access:Get full text
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Summary:Background and Objective In England, the uptake of direct oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation has been slow and varied across different Clinical Commissioning Groups (CCGs). This study aimed to profile the prescribing of oral anticoagulants for stroke prevention in patients with atrial fibrillation over 3 years in a CCG without restrictions to DOACs use to understand more about organisational and/or individual barriers to the early uptake of DOACs. Methods Data were collected from nine general practices between 1 April 2012 and 31 March 2015 of patients who were initiated on the oral anticoagulant therapy. Data were analysed descriptively and with independent Student’s t test and Chi square test to explore if there was an association between type of oral anticoagulant initiated and sex, age, type of prescriber and prior aspirin use. Results The early uptake of DOACs significantly increased over the study period ( p  < 0.0001; medium size effect φc = 0.372). There was no statistically significant difference between sex or age and type of oral anticoagulant initiated. Primary-care prescribers were responsible for initiating the majority of oral anticoagulants (71%; N  = 257) and driving the use of DOACs (72%, N  = 71). Patients switched from aspirin to an oral anticoagulant were more likely to be initiated on warfarin than a DOAC. Conclusions The early use of DOACs, in a CCG without restrictions to their use, was embraced by primary-care prescribers in this particular CCG.
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ISSN:1173-2563
1179-1918
1179-1918
DOI:10.1007/s40261-019-00763-y