Abstract 18238: Transition from Vitamin-K-antagonists to New Oral Anticoagulants in Daily Care - First Results of the Prospective NOAC Registry (NCT 01588119)

Abstract

Background: New oral anticoagulants (NOAC) have been approved in a number of countries for long-term anticoagulation in atrial fibrillation (AF) and venous thromboembolism (VTE). Currently, many patients are switched from Vitamin-K antagonists (VKA) to NOAC. We evaluated the transition process (time gap between last intake of VKA, last INR sampling and first intake of NOAC) in unselected patients from daily care.

Patients and methods: A network of 115 physicians from private practice and hospitals enrol patients in the NOAC registry. Inclusion criteria are: 1) indication for NOAC anticoagulation >3 month; 2) age > 18 years; 3) written informed consent; 4) availability for follow-up. No Exclusion criteria apply. Patients are prospectively followed by phone visits at day 30 day and quarterly thereafter to collect efficacy and safety data.

Results: Until June 6^th 2012, 683 patients were registered. Of the 266 patients switched from VKA, data on the transition process were available in 213 patients (70.0% AF, 30.0% VTE). Of these, only 104 patients (48.8%) had a recorded INR measurement at the end or within 7 days before the end of VKA treatment (mean INR 2.4 for all, 2.6 in AF and 2.1 in VTE patients; table 1). In patients with INR tests, time between last INR and start of NOAC was around 3 days (5 days in AF and 2 days in VTE patients). For all patients, time between last VKA and start NOAC was around 7 days (8 days in AF; 4 days in VTE patients).

Conclusion: In unselected patients in daily care, only 50% of patients have a documented INR test before NOAC is started. Despite documented INR values in the lower therapeutic range, physicians are reluctant to start NOAC therapy immediately and allow for another 2 to 5 days before NOAC is started. However, no major vascular events or major bleedings were observed in VKA transition patients at day 30, indicating that this procedure is safe.