Abstract 16014: Initiation of Dabigatran vs. Warfarin in Anticoagulant Naïve Atrial Fibrillation Patients: A Nationwide Study
Background: Dabigatran is a new oral anticoagulation (OAC) agent approved for stroke prophylaxis in atrial fibrillation (AF) and has been available from August 2011. Little ‘real-world’ information is available on how dabigatran is being adopted in clinical practice.
Methods: Using a Danish nationwide administrative dataset we identified all AF patients initiating oral anticoagulation from August 2011 through December 2011. Patients with valvular AF, previous tromboembolism, or recent orthopedic surgery were excluded (n=43). Temporal utilization trends were compared between initiators of warfarin and dabigatran. Logistic regression analysis with backward selection was used to assess factors associated with initiation of dabigatran instead of warfarin.
Results: We included 924 anticoagulant-naïve AF patients; 624 (68%) initiated warfarin treatment and 300 (32%) dabigatran. Patients who were initiated on dabigatran were older compared with warfarin patients (mean age 73.5, STD 10.2 years vs. 70.8, STD 11.7 years, p for difference 0.005). The two groups were balanced in terms of comorbidites and use of concomitant pharmacotherapy. Predicted thromboembolic risk measured by the CHA2DS2-VASc score was similar between the groups (p for difference 0.8). During the study period, the use of dabigatran increased at the expense of warfarin (Figure). In August 2011, 90% of patients were initiated on warfarin, but in December 2011 this number decreased to 58% (p for trend <0.0001). After multivariable adjustment, age was significantly associated with the initiation of dabigatran relative to warfarin (odds ratio 1.23, 95% CI: 1.09-1.40 per 10 year increments in age).
Conclusion: Dabigatran is being adopted rapidly among Danish AF patients who are naïve to anticoagualnt therapy. More studies are needed to assess the clinical importance of these changes (e.g. incidence of bleeds) in the treatment of AF.
- © 2013 by American Heart Association, Inc.