Analysis of anticoagulant prescribing in non-valvular atrial fibrillation and development of a clinical tool for guiding anticoagulant selection

Atrial fibrillation (AF) is the most common cardiac arrhythmia in the United States. Traditionally, warfarin has been used to prevent the occurrence of stroke in intermediate-to-high risk patients. Target-specific oral anticoagulants (TSOACs) have become a favorable alternative; however, recommendations for differentiating between the available TSOACs were lacking within the 2012 CHEST guidelines. The objective of this retrospective, observational study was to identify current anticoagulation prescribing habits in patients admitted with new-onset AF, and evaluate the appropriateness of discharge therapy based on national guidelines. Additionally, a practice guideline was created for use at our institution to stratify appropriate use of TSOACs. Patients were included if they were at least 18 years old and were admitted with a primary diagnosis of new-onset, non-valvular AF between July 1, 2012 and June 30, 2013. CHADS₂, CHA₂DS₂VASc, and HAS-BLED scores were calculated based on patient data. Between July 2012 and June 2013, 143 patients were included in the study. The average CHADS₂ score was 1.7, the average CHA₂DS₂VASc score was 3.0, and the average HAS-BLED score was 2.4. The use of no antithrombotics decreased as the CHA₂DS₂VASc score increased, aspirin use stayed consistent across risk groups, warfarin use increased as the CHA₂DS₂VASc score increased, and TSOAC use decreased with increasing CHA₂DS₂VASc score. A total of 34 % of study patients were prescribed inappropriate treatment upon discharge, based on national guidelines. This study demonstrated that patients admitted to our hospital were prescribed appropriate therapy the majority of the time; however, 34 % were prescribed inadequate antithrombotic therapy compared to current practice guidelines given their CHA₂DS₂VASc score. The development of an institution-specific guideline stratifying appropriate use of anticoagulation in this population may increase adherence to national guideline recommendations.