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Abstract

Background: Although utilization of anticoagulation in patients with atrial fibrillation (AF) has increased in recent years, contemporarydata regarding thromboembolism and mortality incidence rates are limited outside of clinical trials. This study aimed toinvestigate the impact of the direct oral anticoagulants (DOACs) on the clinical outcomes of patients with AF included in theTasmanian Atrial Fibrillation Study. Methods: The medical records of all patients with a primary or secondary diagnosis of AFwho presented to public hospitals in Tasmania, Australia, between 2011 and 2015, were retrospectively reviewed. We investigatedoverall thromboembolic events (TEs), ischemic stroke/transient ischemic attack (IS/TIA), and mortality incidence rates inpatients admitted to the Royal Hobart Hospital, the main teaching hospital in the state. We compared outcomes in 2 time periods:prior to the availability of DOACs (pre-DOAC; 2011 to mid-2013) and following their general availability after governmentsubsidization (post-DOAC; mid-2013 to 2015). Results: Of the 2390 patients with AF admitted during the overall study period,942 patients newly prescribed an antithrombotic medication (465 and 477 from the pre-DOAC and post-DOAC time periods,respectively) were followed. We observed a significant decrease in the incidence rates of overall TE (3.2 vs 1.7 per 100 patientyears[PY]; P P ¼ .022) in the post-DOAC compared to the pre-DOAC period. All-causemortality was significantly lower in the post-DOAC period (2.9 vs 2.2 per 100 PY, P ¼ .028). Increasing age, prior stroke, andadmission in the pre-DOAC era were all risk factors for TE, IS/TIA, and mortality in this study population. The risk of IS/TIA wasmore than doubled (hazard ratio: 2.54; 95% confidence interval: 1.17-5.52) in current smokers compared to ex- and nonsmokers.Conclusion: Thromboembolic event and all-cause mortality rates were lower following the widespread availability of DOACs inthis population.

Item Type:	Article
Authors/Creators:	Admassie, E and Chalmers, L and Bereznicki, LR
Keywords:	Thromboembolism, atrial fibrillation, mortality
Journal or Publication Title:	Journal of cardiovascular pharmacology and therapeutics
Publisher:	Sage Publications
ISSN:	1074-2484
DOI / ID Number:	https://doi.org/10.1177/1074248418769638
Copyright Information:	Copyright The Author(s) 2018
Related URLs:	UTAS Profile: Chalmers, L Google Scholar: Bereznicki, LR UTAS Profile: Bereznicki, LR
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