OBJECTIVES: The use of non-vitamin K antagonist oral anticoagulants (NOACs) for systemic thrombosis prophylaxis in atrial fibrillation (AF) is increasing rapidly. We compared characteristics of AF patients whether initiation and initiated on NOACs versus warfarin before and after the adoption of NOACs (2011) in practice.

METHODS: Patients newly diagnosed with AF were identified from 1/1/2008 to 6/30/2017 from the largest medical institute in Taiwan. We compared patient characteristics, comorbid conditions, prior 3 months medications in patients initiated with warfarin or NOACs. Differences were examined using multivariable logistic regression models. Cochran–Armitage tests were performed to examine monthly trend uses of OACs.

RESULTS: We amalyzed 52,683 OAC prevalent users of whom 53% were on warfarin and rivaroxaban (28%), dabigatran (9.4%), apixaban (6.4%), edoxaban (3.3%). The monthly users continued to growth after 2011 with average 7% (Trend test, P<.001). Of incident users, 15.7% edoxaban patients had the highest proportion have ever used other OACs. Comparing to AF before 2011, patients initiated with OAC were older (71±11.6 vs 70±11.6), higher CHADS-VASc scores >3 (36.2% vs 35%) and Charlson comorbidity index score>3 (10.2% vs 8.6%). Elderly patients [adjusted odds ratio (aOR) 1.16, 95% CI 1.06-1.27], female (aOR 1.30, 95%CI 1.17-1.45) and patients with a higher CHADS-VASc scores >=2 (aOR 1.21, 95%CI 1.03-1.04) were significantly likely to choose NOACs. A history of higher CCI score >3 (aOR 0.84, 95% CI 0.74-0.95) was less likely to be initiated on a NOAC.

CONCLUSIONS: NOACs adoption increased opportunity to more patients who might benefit from a particular OAC. Substantial proportion of patients having NOACs switches highlight the needs for direct comparative effectiveness comparisons among NOACs, especially in patients with multiple comorbid conditions or contraindications of OACs. These results can facilitate the decision making to identify patient-specific factors, which help tailor the anticoagulant choice and improve the cost-effectiveness of anticoagulation.