Approximately 40% of patients with atrial fibrillation
(AF) remain without preventive anticoagulation therapy. With the availability of
new and more convenient oral anticoagulants, this study was conducted to assess
the proportions of hospitalized patients with nonvalvular atrial fibrillation (NVAF)
prescribed anticoagulation on discharge during a one year time before and after
FDA approval of dabigatran and rivaroxaban.
A retrospective, cross-sectional study was conducted to examine the frequency of
oral anticoagulation in hospitalized patients with NVAF. Non-pregnant, adult patients
with an International Classification of Diseases,
9th Revision, Clinical Modification Code of 427.31 with
CHADS2 > 1 discharged between 7-2009 and 6-2010 (before approval
of the new oral anticoagulants) and between 7-2011 and 6-2012 (after drug approval)
were eligible for inclusion. Patients’ demographics, comorbidities, oral anticoagulant
drug and dose, concomitant medications at discharge, laboratory data, and contraindications
to anticoagulation regimen were documented.
A total of 1,629 charts were identified in the first timeframe (2009-2010) and 1,957
charts in the second timeframe (2011-2012). Five hundred twenty-nine charts were
screened; 362 were excluded (incomplete charts, duplicate patients, or CHADS2
= 0), leaving 83 and 84 patients eligible for analysis in 2009-2010 and 2011-2012,
respectively. No significant difference was detected between proportions of patients
discharged on an anticoagulant during the two time periods (59% for 2009-2010 versus
53.5% for 2011-2012, p = NS). At least one relative contraindication (e.g., past
history of bleeding events or falls) was documented for 38.6% and 30% (p = 0.14)
of the patients, respectively.
New and more convenient options did not appear to improve the proportion of hospitalized
patients prescribed anticoagulation for stroke prevention in NVAF. Further exploration
of barriers to anticoagulation therapy for stroke prevention in NVAF is needed.