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Uptake of non-vitamin K antagonist oral anti coagulants in patients with atrial fibrillation - a prospective cohort study

Matylda Zimny, Steffen Blum, Peter Ammann, Paul Erne, Giorgio Moschovitis, Marcello Di Valentino, Dipen Shah, Jürg Schläpfer, Cyrill Vogt, Alexandra Tabord, Michael Kühne, Christian Sticherling, Stefan Osswald & David Conen

abstract

AIMS
We aimed to assess the uptake of non-vitamin K antagonist oral anticoagulants (NOACs) among patients with atrial fibrillation between 2010 and 2015 in Switzerland.

METHODS
We performed a prospective observational cohort study. At the baseline examination and during yearly follow-ups, we used questionnaires to obtain information about clinical characteristics and antithrombotic treatment. Stroke risk was assessed using the CHA2DS2-VASc score.

RESULTS
1545 patients were enrolled across seven centres in Switzerland. Mean age was 68 ± 12 years and 29.5% were female. The percentage of anticoagulated patients with an indication for oral anticoagulation (CHA2DS2-VASc score ≥2 in women and ≥1 in men) was 75% in 2010 and 80% in 2015 (p = 0.2). There was a gradual increase in the use of NOACs from 0% in 2010 to 29.8% in 2015 (p <0.0001). Out of 888 patients, who initially received a vitamin K antagonist (VKA), 86 (9.7%) were switched to an NOAC during follow-up. Use of aspirin as a monotherapy decreased from 23% in 2010 to 11% in 2015 (p <0.0001).

CONCLUSION
After regulatory approval, the use of NOACs in Switzerland steadily increased to about 30% in 2015, whereas switches from VKAs to NOACs were infrequent. In parallel, the prescription of aspirin as monotherapy was more than halved, suggesting significant guideline-concordant improvements in oral anticoagulation use among patients with atrial fibrillation.
   
citation Zimny M, Blum S, Ammann P, Erne P, Moschovitis G, Di Valentino M, Shah D, Schläpfer J, Vogt C, Tabord A, Kühne M, Sticherling C, Osswald S, Conen D. Uptake of non-vitamin K antagonist oral anti coagulants in patients with atrial fibrillation - a prospective cohort study. Swiss Med Wkly 2017; 147:w14410.
   
type journal paper/review (English)
date of publishing 21-03-2017
journal title Swiss Med Wkly (147)
ISSN electronic 1424-3997
pages w14410
PubMed 28322423
DOI 10.4414/smw.2017.14410