Abstract P255: Use of Novel Oral Anticoagulants Among Patients With Atrial Fibrillation Increased Even in Those With Severely Impaired Kidney Function
Novel oral anticoagulants (NOACs) are increasingly prescribed as substitutes for warfarin in patients with atrial fibrillation (AF). All of the NOACs are at least partially renally cleared, but most trials excluded patients with severe kidney dysfunction. Despite this, labels include dosing for creatinine clearance 15-30 ml/min. The objective of the study was to estimate the prevalence of NOAC use over time among people with AF, stratified by stage of chronic kidney disease (CKD). Study population included 17,280 patients with AF and at least one prescribed anticoagulant (warfarin, dabigatran, rivaroxaban, or apixaban) between 2010 and 2016 in the Geisinger Health System, a large rural health care system in Pennsylvania. Medication information was obtained from both medication orders and records. Average age of the study population was 73.6 years, 46.6% (N=8,044) were women, 98.4% (N=17,009) were Non-Hispanic White, and average estimated glomerular filtration rate (eGFR) was 70.2 ml/min/1.73 m2. Over the course of 2010-2016, 3.0% (N=513), 6.9% (N=1,184) and 4.6% (N=792) received at least one prescription for dabigatran, rivaroxaban, or apixaban. NOAC ever-users (N=2,392) were younger (69.1 vs. 74.3 years, P<0.001) and had a higher eGFR (77.7 vs. 69.9 ml/min/1.73 m2) than warfarin-only users (N=14,888). Prescription of NOACs increased from 0% to 14.7% from 2010 to 2016 (P<0.001). Prescription of NOACs increased in each category of CKD (G1-2, G3 and G4-5, all P<0.001) (Figure 1). The most frequently prescribed NOAC in 2016 was rivaroxaban (8.2%) among those with eGFR>60 ml/min/1.73 m2 and apixaban (5.9% and 4.9%) among those with eGFR 30-60 ml/min/1.73 m2 and eGFR<30 ml/min/1.73 m2, respectively. Among the 22 patients prescribed apixaban with eGFR<30 ml/min/1.73 m2 in 2016, 22.7% (5 of 22) had eGFR<15 ml/min/1.73 m2. In conclusion, NOAC prescriptions increased among patients with AF in all stages of CKD. Further studies to quantify the effectiveness and safety of NOACs compared to warfarin by stage of CKD are warranted.
Author Disclosures: J. Shin: None. A. Secora: None. J. Coresh: None. A.R. Chang: None. M.E. Grams: None.
- © 2017 by American Heart Association, Inc.