PURPOSE: Oral anticoagulants are the recommended cornerstone therapy for stroke prevention in high-risk patients with Atrial Fibrillation (AF) and for years warfarin has been the recommended first-line therapy for stroke prevention. Recently, Direct Oral Anticoagulants (DOACs) were shown to be superior to warfarin for stroke prevention and thus guidelines changed. Whether providers switched patients from warfarin to DOACs following these guideline changes has not been examined.
METHODS: Data are from the ongoing Systematic Assessment of Geriatric Elements in Atrial Fibrillation (SAGE-AF) prospective cohort study, conducted from 2016 to 2020. Participants included those with AF age 65 years or older, CHA2DS2-VASc score of 2 or higher, and no oral anticoagulant contraindications (n = 1244). Geriatric elements were measured using a six-component geriatric assessment. Clinical elements, including oral anticoagulation use and type, were abstracted from participantsÕ electronic medical records.
RESULTS: A total of 1244 participants were enrolled. At baseline, 86% of participants were prescribed oral anticoagulants. At the end of the study, 7% had stopped therapy, 85% were maintained on the same oral anticoagulant, and 8% had switched oral anticoagulants.
CONCLUSION: Less than 10% of older patients with AF switched from warfarin to DOACs following guideline changes. Geriatric impairments were common in the cohort, but prescribing patterns for oral anticoagulants did not differ by impairment status. Prescribing patterns also did not differ by variation in medical history, suggesting patterns may be influenced by prescriber preference or otherwise.