Background:

Major atrial fibrillation (AF) guidelines recommend non-vitamin K antagonist oral anticoagulants (NOACs) over warfarin, except in rare clinical circumstances based on 4 randomized controlled trials comparing each NOAC with warfarin. We aimed to investigate the current NOAC prescription behaviors in alignment with the recent clinical evidence available.

Method:

We conducted a cross-sectional analysis of NOAC-using patients with non-valvular atrial fibrillation (NVAF) who were aged ≥65 years on the index date (July 1, 2018) based on nationwide claims data. The types of NOACs being taken were analyzed using chi-squared tests, and factors influencing NOAC selection were identified using multinomial logistic regression analysis.

Results:

A total of 6,061 patients were included. Among the 4 NOACs, rivaroxaban was the most used NOAC. Patients aged ≥75 years (odds ratio [OR] = 1.270, confidence interval [CI] = 1.089-1.450) and women (OR = 1.148, CI = 1.011-1.284) were more likely to use apixaban relative to rivaroxaban. Patients with prior stroke/transient ischemic attack/thromboembolism had higher odds of using dabigatran (OR = 1.508, CI = 1.312-1.704) and apixaban (OR = 1.186, CI = 1.026-1.346). Patients with renal disease had higher odds of using apixaban (OR = 1.466, 95% CI = 1.238-1.693). These findings are consistent with the efficacy and safety profiles reported in pivotal trials and observational studies comparing individual NOACs.

Conclusion:

Among the 4 NOACs, rivaroxaban was the most commonly used NOAC. Apixaban was preferred for patients aged ≥75 years, females, and patients with renal disease.

中文翻译：

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影响选择非维生素 K 拮抗剂口服抗凝剂预防非瓣膜性心房颤动患者卒中的因素

背景：

主要心房颤动 (AF) 指南推荐非维生素 K 拮抗剂口服抗凝剂 (NOAC) 优于华法林，但基于 4 项随机对照试验比较每种 NOAC 与华法林的罕见临床情况除外。我们的目的是根据最近可用的临床证据调查当前的 NOAC 处方行为。

方法：

我们根据全国理赔数据，对索引日（2018 年 7 月 1 日）年龄≥65 岁的非瓣膜性心房颤动 (NVAF) 患者进行了横断面分析。使用卡方检验分析正在服用的 NOAC 的类型，并使用多项逻辑回归分析确定影响 NOAC 选择的因素。

结果：

共纳入 6,061 名患者。在 4 种 NOAC 中，利伐沙班是最常用的 NOAC。与利伐沙班相比，年龄≥75 岁的患者（优势比 [OR] = 1.270，置信区间 [CI] = 1.089-1.450）和女性（OR = 1.148，CI = 1.011-1.284）更有可能使用阿哌沙班。既往卒中/短暂性脑缺血发作/血栓栓塞的患者使用达比加群（OR = 1.508，CI = 1.312-1.704）和阿哌沙班（OR = 1.186，CI = 1.026-1.346）的几率更高。肾病患者使用阿哌沙班的几率更高（OR = 1.466, 95% CI = 1.238-1.693）。这些发现与比较单个 NOAC 的关键试验和观察性研究中报告的疗效和安全性概况一致。

结论：

在 4 种 NOAC 中，利伐沙班是最常用的 NOAC。阿哌沙班首选用于年龄≥75 岁的患者、女性和肾病患者。