Comorbidities and Antithrombotic Treatment Pattern in Patients With Atrial Fibrillation

Oh Young Bang; Siin Kim; Young Keun On; Myung-Yong Lee; Sung-Won Jang; Seongwook Han; Jaeyun Ryu; Seongsik Kang; Hae Sun Suh; Young-Hoon Kim

doi:10.3389/fneur.2022.761603

Comorbidities and Antithrombotic Treatment Pattern in Patients With Atrial Fibrillation

Front Neurol. 2022 Mar 4:13:761603. doi: 10.3389/fneur.2022.761603. eCollection 2022.

Authors

Oh Young Bang¹, Siin Kim², Young Keun On³, Myung-Yong Lee⁴, Sung-Won Jang⁵, Seongwook Han⁶, Jaeyun Ryu⁷, Seongsik Kang⁷, Hae Sun Suh², Young-Hoon Kim⁸

Affiliations

¹ Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
² College of Pharmacy, Kyung Hee University, Seoul, South Korea.
³ Department of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
⁴ Division of Cardiology, Department of Internal Medicine, Dankook University, Chung Nam, South Korea.
⁵ Division of Cardiology, Department of Internal Medicine, Catholic University of Korea, Seoul, South Korea.
⁶ Division of Cardiology, Department of Internal Medicine, Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea.
⁷ Pfizer Korea Ltd., Seoul, South Korea.
⁸ Division of Cardiology, Department of Internal Medicine, Korea University, Seoul, South Korea.

Abstract

Objective: Non-vitamin K antagonist oral anticoagulants (NOACs) are proven alternatives to warfarin for preventing stroke in patients with non-valvular atrial fibrillation. We aimed to examine the treatment patterns and patient factors associated with the use of antiplatelet agents, warfarin, and NOACs in clinical practice.

Methods: We conducted a retrospective cohort study using the Korean Health Insurance Review & Assessment Service database. Patients receiving antithrombotics were identified before and after the introduction of NOACs (from August 1, 2013 to December 30, 2014 and July 1, 2015 to November 30, 2016, respectively). Patients were included if they were aged ≥18 years, had an atrial fibrillation diagnosis, and had a CHA₂DS₂-VASc score ≥2. Treatment pattern was assessed by classifying patients into NOAC, warfarin, or antiplatelet users based on the first date of antithrombotic prescription. Clinical factors associated with the type of antithrombotics chosen were examined using logistic regression analyses.

Results: We identified 129,465 and 196,243 patients before and after the introduction of NOACs, respectively. The proportion of antiplatelet users was 60.7 and 53.0% before and after the introduction of NOACs, respectively. The proportion of warfarin users was higher in patients with low HAS-BLED score, high CHA₂DS₂-VASc score, or stroke before the NOAC era. A similar trend was observed for NOAC and warfarin users after the introduction of NOAC. Compared with antiplatelets, warfarin and NOAC uses were significantly associated with CHA₂DS₂-VASc score and stroke, whereas presence of myocardial infarction (MI) and peripheral arterial disease were significantly associated with antiplatelets prescription. For comparisons between NOAC and warfarin, HAS-BLED and CHA₂DS₂-VASc scores showed significant associations with NOAC use, whereas comorbidities including MI were significantly associated with warfarin use.

Conclusions: The treatment pattern of antithrombotics did not change with the introduction of NOACs. However, comorbidities served as an important factor in choosing treatment regardless of NOAC entry.

Keywords: NOAC; atrial fibrillation; stroke; systemic embolism; warfarin.