The impact of renal function on efficacy and safety of new oral anticoagulant in atrial fibrillation patients

Abstract Background Care coordination between general practitioners (GPs) and cardiovascular specialists is expected to play a key role in establishing appropriate oral anticoagulant (OAC) treatment in atrial fibrillation (AF) patients. The aim of this study was to assess the impact of care coordination on oral anticoagulant therapy in the management of AF in Japan. Methods This study was a multi-center, single-arm, prospective cohort study with retrospective chart and claims data review for historical controls. The study included three study periods: a 12-month pre-campaign period; a 12-month campaign period for AF screening and care coordination; and a 3-month post-campaign period for follow-up of care coordination. During the campaign period, patients aged ≥65 years who attended participating GP clinics underwent opportunistic AF screening by GPs under the campaign. At the discretion of the GP, newly diagnosed AF patients after the screening were referred to a cardiovascular specialist for care coordination. To assess the impact of care coordination and evaluate the effects of the campaign, implementation of care coordination, antithrombotic therapies, and patient-reported outcomes were compared between patients with and without care coordination, and between patients during the pre-campaign and campaign periods. Results There were 86 newly diagnosed AF patients during the pre-campaign period and 90 during the campaign period. The percentage of patients with care coordination increased from 3.5% (3/86) in the pre-campaign period to 14.4% (n = 13/90) during the campaign period. The percentage of patients who received OAC therapies, according to the definition from the Japanese AF medication guideline, increased from 55.8% (48/86) to 71.1% (64/90) during the campaign period regardless of care coordination. Younger patients were referred to cardiovascular specialists for care coordination. Implementation of OAC therapy did not differ between patients with and without care coordination. Adherence to OAC therapy was low regardless of care coordination. Conclusions This GP-targeted campaign was effective at raising awareness regarding the implementation of care coordination and appropriate OAC therapy at local clinical practices in Japan. Improvement of adherence to OAC therapy in elderly patients is a critical issue, and measures such as education programs targeted to patients and healthcare professionals should be undertaken.

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Régi és új orális antikoagulánsok hazai alkalmazása pitvarfibrillációban

Orvosi Hetilap ◽

10.1556/650.2017.30802 ◽

2017 ◽

Vol 158 (39) ◽

pp. 1545-1549

Author(s):

János Tomcsányi ◽

Balázs Salfer ◽

Bence Nagy

Keyword(s):

Atrial Fibrillation ◽

Vitamin K ◽

Oral Anticoagulant ◽

Oral Anticoagulant Therapy ◽

Real Life ◽

Vitamin K Antagonist ◽

Anticoagulant Treatment ◽

Oral Anticoagulant Treatment ◽

New Oral Anticoagulant ◽

Method Analysis

Abstract: Introduction: Despite a progress in the management of patients with atrial fibrillation this arrhythmia is one of the major causes of stroke, heart failure, sudden death and cardiovascular morbidity. Oral anticoagulation with vitamin K antagonist or non-vitamin K antagonist markedly reduces stroke and mortality in atrial fibrillation patients. Aim: To estimate the real-life vitamin K antagonist and non-vitamin K antagonist oral anticoagulant treatment in past years in Hungary. Method: Analysis of the National Health Insurance Administation database for atrial fibrillation (BNO: I48) between 2010–2015. We assumed that AF patient would turn to health care provides at least once either as inpatients or outpatients in a 5-year period. The patient was accepted as adherent after 6 months therapy and at least 80% oral anticoagulant prescription. Results: The prevalence of AF in Hungary is 3%. The mortality rate of AF 7%–10% per year. The adherence of the old oral anticoagulant treatment was 55%, but it was 69% among patient treated by “new” oral anticoagulant treatment. However, one third of the patients are not treated by effective old or new oral anticoagulant treatment. Conclusions: We need more effort to improve the effective and high adherence oral anticoagulant therapy in our country. Orv Hetil. 2017; 158(39): 1545–1549.

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Development of delayed cardiac tamponade 55 days after catheter ablation for atrial fibrillation with a new oral anticoagulant

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-014-9926-7 ◽

2014 ◽

Vol 41 (2) ◽

pp. 135-135 ◽

Cited By ~ 5

Author(s):

Takeshi Kitamura ◽

Seiji Fukamizu ◽

Harumizu Sakurada ◽

Masayasu Hiraoka

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Cardiac Tamponade ◽

Oral Anticoagulant ◽

New Oral Anticoagulant

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MP280A NEW ORAL ANTICOAGULANT THERAPY IN PATIENTS WITH NONDIALYSIS CHRONIC KIDNEY DISEASE AND ATRIAL FIBRILLATION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfw188.36 ◽

2016 ◽

Vol 31 (suppl_1) ◽

pp. i432-i432

Author(s):

Ingrid Prkačin ◽

Tomislav Bulum ◽

Borna Vrhovec ◽

Lana Šambula ◽

Ana Legović ◽

...

Keyword(s):

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Anticoagulant Therapy ◽

Oral Anticoagulant ◽

Oral Anticoagulant Therapy ◽

New Oral Anticoagulant

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Impact of liver disease on oral anticoagulant prescription and major adverse events in patients with atrial fibrillation: analysis from a population-based cohort study

European Heart Journal ◽

10.1093/ehjci/ehaa946.0684 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Proietti ◽

I Marzona ◽

T Vannini ◽

P Colacioppo ◽

M Tettamanti ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Liver Disease ◽

Risk Ratio ◽

Major Bleeding ◽

Oral Anticoagulant ◽

Population Based ◽

Primary Study ◽

Secondary Bleeding ◽

The Impact

Abstract Aims Data on the impact of liver disease (LD) in patients with atrial fibrillation (AF) and the role of oral anticoagulant (OAC) drugs for stroke prevention, are limited. We analysed the impact of LD and OAC treatment in determining stroke, major bleeding, all-cause death and secondary bleeding outcomes. Methods A retrospective observational population-based cohort study. The study cohort is derived from the administrative health databases of Lombardy region (>10 million inhabitants), Italy. All AF patients ≥40 years admitted to hospital from 2000 to 2018 were considered. AF and LD diagnosis were established using ICD9-CM codes. Use of OAC was determined with Anatomical Therapeutic Chemical (ATC) codes. Primary study outcomes were stroke, major bleeding and all-cause death. Results Among 393,507 AF patients, 16,168 (4.1%) had concomitant LD. LD AF patients were significantly less treated with OAC independent of associated clinical characteristics (OR: 0.96, 95% CI: 0.92–0.98). Concomitant LD was found associated with an increased risk in all the study outcomes (HR: 1.18, 95% CI: 1.11–1.25 for stroke; HR: 1.57, 95% CI: 1.47–1.66 for major bleeding; HR: 1.41, 95% CI: 1.39–1.44 for all-cause death. Use of OAC in patients with AF and LD resulted in a reduction in stroke (HR: 0.80, 95% CI: 0.70–0.92), major bleeding (HR: 0.86, 95% CI: 0.74–0.99) and all-cause death (HR: 0.85, 95% CI: 0.80–0.90), with similar results according to several clinically relevant subgroups. A net clinical benefit (NCB) analysis suggested a positive benefit/risk ratio in using OAC in AF patients with LD (NCB: 0.408, 95% CI: 0.375–0.472). Conclusions In AF patients, concomitant LD carries a significantly higher risk for all clinical outcomes. Use of OAC in AF patients with LD was associated with a significant benefit/risk ratio, even in high-risk patient subgroups. Funding Acknowledgement Type of funding source: None

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Efficacy and safety of edoxaban compared with warfarin according to the burden of diseases in patients with atrial fibrillation: insights from the ENGAGE AF-TIMI 48 trial

European Heart Journal - Cardiovascular Pharmacotherapy ◽

10.1093/ehjcvp/pvz061 ◽

2019 ◽

Vol 6 (3) ◽

pp. 167-175 ◽

Cited By ~ 3

Author(s):

André M Nicolau ◽

Ramon Corbalan ◽

Jose C Nicolau ◽

Christian T Ruff ◽

Wolfgang Zierhut ◽

...

Keyword(s):

Atrial Fibrillation ◽

Clinical Outcomes ◽

Oral Anticoagulants ◽

Concomitant Disease ◽

Efficacy And Safety ◽

Treatment Groups ◽

Comorbidity Index ◽

Post Hoc ◽

The Impact ◽

Burden Of Diseases

Abstract Aims Non-vitamin K antagonist oral anticoagulants represent a new option for prevention of embolic events in patients with atrial fibrillation (AF). However, little is known about the impact of non-cardiac comorbidities on the efficacy and safety profile of these drugs. Methods and results In a post hoc analysis of the ENGAGE AF-TIMI 48 trial, we analysed 21 105 patients with AF followed for an average of 2.8 years and randomized to either a higher-dose edoxaban regimen (HDER), a lower-dose edoxaban regimen, or warfarin. We used the updated Charlson Comorbidity Index (CCI) to stratify the patients according to the burden of concomitant disease (CCI = 0, 1, 2, 3, and ≥4). The treatment groups were then compared for safety, efficacy, and net clinical outcomes across CCI categories. There were 32.0%, 7.3%, 42.1%, 12.7%, and 6.0% of patients with CCI scores of 0, 1, 2, 3, and ≥4, respectively. A CCI score ≥4 was associated with significantly higher rates of thromboembolic events, bleeding, and death compared to CCI = 0 (P < 0.05 for each). The annualized rates of the primary net clinical outcome (stroke/systemic embolism, major bleeding, or death) for CCI = 0, 1, 2, 3, or ≥4 were 5.9%, 8.7%, 6.6%, 10.3%, and 13.6% (Ptrend < 0.001). There were no significant interactions between treatment with HDER vs. warfarin and efficacy, safety, and net outcomes across the CCI groups (P-interaction > 0.10 for each). Conclusion Although increasing CCI scores are associated with worse outcomes, the efficacy, safety, and net clinical outcomes of edoxaban vs. warfarin were independent of the degree of comorbidity present.

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Which Patients Would Be Willing to Change Anticoagulation From Vitamin-K Antagonists to a New Oral Anticoagulant?

Blood ◽

10.1182/blood.v118.21.4318.4318 ◽

2011 ◽

Vol 118 (21) ◽

pp. 4318-4318

Author(s):

Job Harenberg ◽

Svetlana Marx ◽

Nadja Abou-Ayash ◽

Christophe Kremer ◽

Vera Hoeing ◽

...

Keyword(s):

Atrial Fibrillation ◽

Logistic Regression ◽

Regression Analysis ◽

Vitamin K ◽

Logistic Regression Analysis ◽

Oral Anticoagulant ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

New Oral Anticoagulant ◽

Willingness To Change

Abstract Abstract 4318 New oral anticoagulants have generated promising data on the prophylaxis of systemic and non-systemic embolism in patients with atrial fibrillation and treatment of acute venous thromboembolism and prolonged prophylaxis of recurrent events. For patients on chronic treatment with vitamin-K antagonists (VKA) we analysed the motivation and willingness to change the anticoagulation from VKA to new oral anticoagulants. Patients (n=110) on stable treatment with VKA for at least 3 months (indication for anticoagulation: atrial fibrillation or VTE) completed a validated personality inventory (Freiburger Persönlichkeitsinventar FPI-R), and a self-developed questionnaire on general attitudes regarding anticoagulant therapy (Q1). Patients were divided in two groups according to the reply to the question weather they were willing to switch to a new oral anticoagulant. Out of these sets of questions 7 questions were identified by means of a logistic regression analysis for the willingness to change anticoagulation with VKA to a new oral anticoagulant. The same patients completed this shortened questionnaire (Q2) (n=85) thereafter. Logistic regression analysis defined the 7 items of the FPI and Q1 questionaires as relevant for willingness of patients to change the medication. The probability to change medication was 98% using the 7 questions (Q2) compared to the 2 comlete questionnaires. The items were: extraversion – introversion scale on the FPI-R consisting of 14 questions, and from Q1: hope for a better quality of life with a new anticoagulant, no scepticism for new drugs, wish of a lack of routine monitoring for dose adjustment, relevance of the practitioners opinion, thoughts in the past of alternatives for anticoagulation, and difficulty to adjust the prothrombin time. Using Q2 85% of patients confirmed to be willing to change the anticoagulant drug compared to Q1 (chi square test p<0.0001). Seven questions were identified and confirmed to identify patients for their willingness to change anticoagulation from VKA to a new oral anticoagulant. Disclosures: No relevant conflicts of interest to declare.

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