Background: Anticoagulation management among non-valvular atrial fibrillation (NVAF) patients has changed during the past decade. It is unclear whether these changes led to improved prognosis in patients with NVAF.

Aims: To investigate changes in prescription patterns of oral anticoagulants (OACs) and prognosis among newly diagnosed NVAF patients.

Methods: The study used Dutch national statistics and included patients who were newly diagnosed with NVAF between 2013 and 2017. Each patient was followed from the date of first NAVF diagnosis for 1 year or until date of death, whichever came first. The included patients were grouped according to calendar years of first NAVF diagnosis. OACs prescription patterns and incidence rates of ischemic stroke and major bleeding during the follow-up were assessed and compared between calendar years of first NAVF diagnosis. The study was approved by the Research Committee of Department of Clinical Epidemiology of the Leiden University Medical Center.

Results: A total of 342,209 newly diagnosed NVAF patients were included. Similar baseline characteristics were observed between patients diagnosed at different years, but the year 2013 saw a slightly younger patient population. OACs were increasingly prescribed since 2013 (from 60.96% in 2013 to 72.87% in 2015), but remained the same from 2015 onwards, and direct oral anticoagulants (DOACs) were gradually replacing Vitamin K antagonists (VKAs) (from 6.14% in 2013 to 63.09% in 2017) (Figure 1).

Decision on oral anticoagulation therapy and choices of oral anticoagulants within 1 year after first non-valvular atrial fibrillation (NVAF) diagnosis among newly diagnosed NVAF patients in the Netherlands stratified by calendar years of first NVAF diagnosis

Except for year 2013, which saw the lowest incidences for all study outcomes, incidences of ischemic stroke remained stable between 2014 and 2017, while the incidences of major bleeding and intracerebral hemorrhage were somewhat decreasing over time (Figure 2).

Incidence rates of clinical outcomes within 1 year after first non-valvular atrial fibrillation (NVAF) diagnosis among newly diagnosed NVAF patients in the Netherlands by calendar years of first NVAF diagnosis

Conclusions: With the changes in prescription patterns of OACs since 2013, favoring DOACs over VKA, the risk of ischemic stroke remained the same but the risk of major bleeding decreased in newly diagnosed NAVF patients in the Netherlands.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/changes-in-prescription-patterns-of-oral-anticoagulants-and-clinical-outcomes-among-newly-diagnosed-non-valvular-atrial-fibrillation-patients-in-the-netherlands/