Author(s)
Bae H1, Heo J2, Jung K3, Lee Y4, Hong K5, Seo W6, Koo J7, Cha J8, Lee MJ9, Seo B10, Kim Y10, Kang S10, Seok J11, Lee J11, Chung C9
1Seoul National University Bundang Hospital, Soengnam, Korea, Republic of (South), 2Severance Hospital, Yonsei University Health System, Seoul, Korea, Republic of (South), 3Seoul National University Hospital, Seoul, Korea, Republic of (South), 4SMG-SNU Boramae Medical Center, Seoul, Korea, Republic of (South), 5Inje University Ilsan Paik Hospital, Goyang, Korea, Republic of (South), 6Korea University Guro Hospital, Seoul, Korea, Republic of (South), 7Seoul St. Mary’s Hospital, Seoul, Korea, Republic of (South), 8Dong-A University Hospital, Busan, Korea, Republic of (South), 9Samsung Medical Center, Seoul, Korea, Republic of (South), 10Pfizer Pharmaceuticals Korea Ltd., Seoul, Korea, Republic of (South), 11Korea University College of Medicine, Seoul, Korea, Republic of (South)
OBJECTIVES: This multicenter observational study aimed to describe patterns of long-term antithrombotic use in acute ischemic stroke (AIS) patients with non-valvular atrial fibrillation (NVAF) in Korea and their impacts on clinical events before introduction of non-vitamin K antagonist oral anticoagulants (NOAC) into practice in 2015. METHODS: Patients with NVAF who were admitted due to the AIS and discharged no later than 2008 were enrolled retrospectively. Information on antithrombotic use and clinical events was collected at 11 time points during the 3 years of follow-up. The primary outcome was a composite of stroke recurrence, major bleeding, and death. Vitamin K antagonist (VKA) users were categorized into a well-controlled INR group and a poorly-controlled INR group using a median modified iTTR ( RESULTS: Of 1,350 patients enrolled in this study, 95% were on antithrombotic medications at discharge. The rate of VKA usage decreased over time (77% and 40% at discharge and 3 years, respectively). Among 26 identified treatment patterns, maintaining VKA-only was most common (47.5%), followed by maintaining antiplatelet-only (12.4%), VKA-only changed to antiplatelet-only (5.1%), and maintaining VKA in combination with antiplatelet (5.0%). The proportions of patients who experienced primary outcome differed by treatment patterns. Among the 10 most frequent treatment types, the highest outcome rate was observed in patients who started VKA-only therapy and discontinued it without any more antithrombotic therapy (70.2%); this was followed by those starting with antiplatelet-only therapy and stopping it without any further antithrombotic treatment (66.7%). The 3-year cumulative primary outcome rates were higher in poorly-controlled groups than well-controlled groups (24.5% vs 15.7%; p = 0.015). CONCLUSIONS: Our study revealed that, in pre-NOAC era, there was a wide spectrum of long-term antithrombotic use in AIS patients with NVAF in Korea. The incidence of the composite outcome (stroke recurrence, major bleeding, and death) varied by patterns of antithrombotic use.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PCV148
Topic
Health Service Delivery & Process of Care
Topic Subcategory
Prescribing Behavior
Disease
Cardiovascular Disorders
