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- Title
The impact of non-vitamin K antagonist oral anticoagulants (NOACs) on anticoagulation therapy in rural Australia.
- Authors
Bellinge, Jamie W.; Paul, Jarrad J.; Walsh, Liam S.; Garg, Lokesh; Watts, Gerald F.; Schultz, Carl
- Abstract
<bold>Objective: </bold>To determine the use of different anticoagulation therapies in rural Western Australia; to establish whether remoteness from health care services affects the choice of anticoagulation therapy; to gather preliminary data on anticoagulation therapy safety and efficacy.<bold>Design: </bold>Retrospective cohort study of patients hospitalised with a principal diagnosis of atrial fibrillation/flutter (AF) or venous thromboembolism (VTE) during 2014-2015.<bold>Setting: </bold>Four hospitals serving two-thirds of the rural population of Western Australia.<bold>Participants: </bold>609 patients with an indication for anticoagulation therapy recorded in their hospital discharge summary for index admission.<bold>Main Outcome Measures: </bold>Prescribing rates of anticoagulation therapies by indication for anticoagulation and distance of patient residence from their hospital. The primary safety outcome was re-hospitalisation with a major or clinically relevant non-major bleeding event; the primary lack-of-efficacy outcome was re-hospitalisation for a thromboembolic event.<bold>Results: </bold>The overall rates of prescription of NOACs and warfarin were similar (34% v 33%). A NOAC was prescribed more often than warfarin for patients with AF (56.0% v 42.2% of those who received an anticoagulant; P < 0.001), but less often for patients with VTE (29% v 48%; P < 0.001). Warfarin was prescribed for 38% of patients who lived locally, a NOAC for 31% (P = 0.013); for non-local patients, the respective proportions were 29% and 36% (P = 0.08). 69% of patients with AF and a CHA2DS2-VASc score ≥ 1 were prescribed anticoagulation therapy. Patients treated with NOACs had fewer bleeding events than patients treated with warfarin (nine events [4%] v 20 events [10%]; P = 0.027).<bold>Conclusions: </bold>In rural WA, about one-third of patients with an indication for anticoagulation therapy receive NOACs, but one-third of patients with AF and at risk of stroke received no anticoagulant therapy, and may benefit from NOAC therapy.
- Subjects
AUSTRALIA; ANTICOAGULANTS; DRUG efficacy; MEDICAL care; ATRIAL fibrillation; HOSPITAL care; MEDICAL prescriptions; ORAL drug administration; RURAL population; THROMBOEMBOLISM; THROMBOLYTIC therapy; VEINS; WARFARIN; TREATMENT effectiveness; RETROSPECTIVE studies
- Publication
Medical Journal of Australia, 2018, Vol 208, Issue 1, p18
- ISSN
0025-729X
- Publication type
journal article
- DOI
10.5694/mja17.00132