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Switching from Vitamin K antagonists to novel oral anticoagulants (NOACs): predictors and outcomes.
Session:
Posters 1 - Écran 08 - HTA / Fármacos /Ciência Básica
Speaker:
Ana Marques
Congress:
CPC 2018
Topic:
L. Cardiovascular Pharmacology
Theme:
31. Pharmacology and Pharmacotherapy
Subtheme:
31.5 Pharmacology and Pharmacotherapy - Other
Session Type:
Posters
FP Number:
---
Authors:
Ana I. Marques; Daniel Caldeira; Sofia Alegria; Ana Rita F. Pereira; Ana Catarina Gomes; Daniel Sebaiti; Dra. Inês Cruz; Isabel João; Helder Pereira
Abstract
<p><strong>Introduction:</strong> Vitamin K antagonists (VKA) were until recently the only oral anticoagulants available for the prevention of some prothrombotic conditions. The approval of novel oral anticoagulants (NOACs) has changed the pattern of oral anticoagulants prescription.</p> <p><strong>Objectives:</strong> To analyse the proportion of patients (pts) that switched from VKA to NOAC, the predictors of switching and the outcomes of VKA vs NOAC.</p> <p><strong>Methods:</strong> We performed a retrospective study that included outpatients who attended the cardiology anticoagulation clinic of our hospital (2011-2013). We selected pts with non-valvular atrial fibrillation or venous thromboembolism. The exclusion criteria comprised follow-up <2 months or <6 International Normalized Ratio (INR) tests, other indications for anticoagulation, estimated glomerular filtration rate <30 mL/min, loss of follow-up or withdrawal of oral anticoagulation.</p> <p><strong>Results:</strong> Were included 237 pts that fulfil the criteria: 157 (66%) were male, mean age 72±10 years, 197 (83%) pts had non-valvular atrial fibrillation and the remain had venous thromboembolism.</p> <p>We retrieved the INR values for a mean period of 464±273 days and the mean time in therapeutic range (TTR) was 56±17%.</p> <p>During a mean follow-up of 54±23months, 199 (84%) pts maintained anticoagulation with warfarin and 38 (16%) pts switched to NOACs.</p> <p>In the univariate regression the absence of medical history of vascular disease (20 vs 9%, p=0.025) and lower CHA<sub>2</sub>DS<sub>2</sub>-VASc scores (3 vs 3.6, p=0.03) were significantly associated to the NOACs switch. The TTR values were not significantly different, despite the trend towards lower TTR for switching (50 vs 56%, p=0.06).</p> <p>The all-cause mortality rate during FUP was significantly lower in switchers (8 vs 27%, p=0.011) but no significant differences were noticed in the cardiovascular mortality, stroke or myocardial infarction. No hemorrhagic events were observed in the NOACs group compared with the 9.5% rate of VKA (0% vs 9.6%, p=0.049).</p> <p><strong>Conclusion:</strong> In this cohort 16% of VKA users were switched to NOACs. The predictors for switching were the absence vascular disease and lower CHA<sub>2</sub>DS<sub>2</sub>-VASc. The all-cause mortality and hemorrhagic events were significantly lower in NOACs group.</p>
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