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Uptake of oral anticoagulants for stroke prevention in patients with atrial fibrillation in a single Clinical Commissioning Group in England without restrictions to their use
Fay, M. Petty, Duncan R.
Fay, M.
Petty, Duncan R.
Publication Date
2019-04
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© Springer Nature Switzerland AG 2019. Reproduced in accordance with the publisher's self-archiving policy.
The final publication is available at Springer via https://doi.org/10.1007/s40261-019-00763-y
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Open Access status
openAccess
Accepted for publication
2019-02-08
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Abstract
Background and Objective In England, the uptake of direct oral anticoagulants (DOACs) for stroke prevention in atrial
fbrillation has been slow and varied across diferent Clinical Commissioning Groups (CCGs). This study aimed to profle
the prescribing of oral anticoagulants for stroke prevention in patients with atrial fbrillation over 3 years in a CCG without
restrictions to DOACs use to understand more about organisational and/or individual barriers to the early uptake of DOACs.
Methods Data were collected from nine general practices between 1 April 2012 and 31 March 2015 of patients who were
initiated on the oral anticoagulant therapy. Data were analysed descriptively and with independent Student’s t test and Chi
square test to explore if there was an association between type of oral anticoagulant initiated and sex, age, type of prescriber
and prior aspirin use.
Results The early uptake of DOACs signifcantly increased over the study period (p<0.0001; medium size efect φc=0.372).
There was no statistically signifcant diference between sex or age and type of oral anticoagulant initiated. Primary-care
prescribers were responsible for initiating the majority of oral anticoagulants (71%; N=257) and driving the use of DOACs
(72%, N=71). Patients switched from aspirin to an oral anticoagulant were more likely to be initiated on warfarin than a
DOAC.
Conclusions The early use of DOACs, in a CCG without restrictions to their use, was embraced by primary-care prescribers
in this particular CCG.
Version
Accepted manuscript
Citation
Medlinskiene K, Fay M and Petty D (2019) Uptake of oral anticoagulants for stroke prevention in patients with atrial fibrillation in a single Clinical Commissioning Group in England without restrictions to their use. Clinical Drug Investigation. 39(4): 401-405.
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Article