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Adelakun, Adenike

University of British Columbia

Introduction: Atrial fibrillation (AF) is the most common clinically significant heart arrhythmia. AF increases the risk of stroke or systemic embolism (SSE) by 3-5 times. Oral anticoagulants (OACs) reduce the risk of SSE in AF patients. Given the differing attributes of the five available OACs, the valuation or preferences of AF patients and the different timelines of approval of the OACs, switching is expected. Objective: To comprehensively describe OAC switching among Canadian patients with AF and to characterize the potential benefits of OAC switching using administrative health data. Methods: A scoping review was used to map the available evidence on OAC switching in patients with AF. To evaluate OAC switching, a longitudinal study was conducted using an established cohort of adult AF patients, using population-based administrative health data in British Columbia (BC). Switching was defined as a change from one OAC to another with ≤30 days gap between the prescriptions. The patterns of OAC switches and switchbacks for patients with more than one switch were characterized. Multivariable Cox regression was used to determine factors associated with OAC switching. A Delphi process was used to develop a taxonomy on the beneficial effects of OAC switching which was applied to information on OAC switching from the longitudinal study using administrative health data. Results: The scoping review revealed many gaps in the literature. Among the cohort of patients with AF in BC, OAC switching was common with 25% of patients in the cohort experiencing at least one switch. Up to 26% of patients on each OAC experienced a switchback to an OAC they had been on before. Stroke, heart failure and vascular disease had the highest hazards for switches between OAC classes. Potential safety, effectiveness, convenience, economic and, drug-interaction benefits to OAC switches were observed. Conclusion: I showed the extent of OAC switching in AF patients and the potential beneficial attributes. Apixaban is increasingly becoming the OAC to switch to. There are more convenience and drug-interaction benefits to OAC switches observed compared to effectiveness, safety and economic benefits. Findings may be useful in AF patient education, health policies, and OAC reimbursement criteria.

Text

2024-07-31

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/82118

Pharmaceutical Sciences

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/