J Pharmacoepidemiol Risk Manage.  2022 Mar;14(1):69-78. 10.56142/2022.14.1.69.

Drug Utilization of Oral Anticoagulants in Patients with Non-valvular Atrial Fibrillation in the Elderly

• Hwang H
• Jung M
• Choo E
• Lee S

• KMID: 2534676
• DOI: http://doi.org/10.56142/2022.14.1.69

Abstract

Objective
The prescription rates for oral anticoagulants (OACs) are increasing, and concerns for the risk of major bleeding in non-valvular atrial fibrillation (NVAF) patients are also on the rise. This study aimed to analyze the prescription trends, efficacy and safety of OACs such as warfarin and direct-acting OACs (DOACs) in patients with NVAF in Korea.
Methods
We conducted a retrospective study using the Health Insurance Review & Assessment Service data (2015). Patients were divided into two groups based on the type of anticoagulant taken: warfarin and DOAC. We evaluated use of OACs and their clinical outcomes. The efficacy outcome was defined as the incidence of stroke or systemic embolism and the safety outcome was major bleeding.
Results
In this study, 2,840 patients used warfarin (64.0%), 936 patients used rivaroxaban (21.1%), and 659 patients used dabigatran (14.9%). The mean age was 75 years. The number of patients who switched from warfarin to rivaroxaban or dabigatran was 286 (10.1%) and 249 (8.7%), respectively. The warfarin group showed no statistically significant difference in terms of major adverse cardiac and cerebrovascular events (MACCE) including stroke (0.92, 95% CI, 0.67-1.47) and major bleeding (0.79, 95% CI, 0.42-1.46) compared to the DOAC groups.
Conclusion
Warfarin was the most commonly prescribed OAC among Korean patients with NVAF in 2015. The two study groups that used warfarin and DOACs showed no significant difference in terms of MACCE and bleeding risk.

Keyword

Non-valvular atrial fibrillation; Warfarin, DOAC; Rivaroxaban; Dabigatran