Many people who suffer from irregular heartbeats (atrial fibrillation) which might cause stroke, need to take blood thinners to prevent it. It is important to prescribe the correct dose of blood thinners to the right patients to ensure the treatment works however avoiding complications. In the recent years, new blood thinners have been available; they require less laboratory tests and fewer visits to a doctor compared to older therapies. This study will look at how the general practitioners in the UK prescribe blood thinners according to the instructions given by the product manufacturer. We will use primary care data that is routinely collected by the general practitioners about their patients but without any possibility to identify individual patients. The results will help us to understand the magnitude of deviation from instructions in order to ensure that the patients benefit from the treatment.
Study Type
OBSERVATIONAL
Enrollment
31,336
Oral direct factor Xa inhibitors, 15mg and 20mg tablets QD
Oral direct thrombin inhibitors, 75mg and 150mg capsules BID
Oral direct factor Xa inhibitors, 2.5mg and 5 mg tablets BID
Many Locations
Multiple Locations, United Kingdom
Demographic Characteristics
* Age * Sex * Smoking status (previous 6 months) * Body mass index (previous 6 months) * Blood pressure history (previous 12 months) * Number of patients that are naïve vs non-naïve For non-naïve: type and duration of anticoagulant used before index date
Time frame: 6 years
Risk factor categories
* C(Congestive heart failure) H(Hypertension)A(Age)D(Diabetes Mellitus)S2(Prior Stroke or TIA) score * C(Congestive heart failure) H(Hypertension)A2(Age ≥75 years)D(Diabetes Mellitus)S2 V(Vascular disease)A(Age 65-74 years)SC(Sex category) * H(Hypertension)A(Abnormal renal and liver function)S(Stroke)B(Bleeding)L(Labile INRs)E(Elderly)D(Drugs or alcohol) score * INR(International Normalized Ratio) measurement
Time frame: 6 years
Previous medical history
* Acute MI(Myocardial Infarction) * Stroke or TIA(Transient Ischemic Attack) * Systemic peripheral arterial embolism * Coronary artery disease * Congestive heart disease * Hypertension * Diabetes Renal disease (eGFR) or ACR (Albumin/Creatinine Ratio)
Time frame: 12 months prior to index date
Previous medication history
* Anti-arrhythmics * Statins * Anti-platelets * Beta-blockers * ACE(Angiotensin-Converting-Enzyme) inhibitors * Anti-diabetic agents * Non-steroidal anti-inflammatory drugs (NSAIDs) * Antacids * Histamine receptor antagonists * Proton pump inhibitors (PPIs) * Disease-modifying anti-rheumatic drugs (DMARDs) * Antidepressants * Antipsychotic agents * Oral contraceptives * Hormone replacement therapy (HRT) * Strong inhibitors of Cytochrome P450 or P-GP * Strong inducers of CYP3A4
Time frame: 12 months prior to index date
Previous use of VKA
* Warfarin * Other Vitamin K antagonist(s)
Time frame: Ever prior to index date
Concurrent co-medication
* Anti-coagulants * Aspirin * Clopidogrel * Other
Time frame: 6 years
Daily dose
DOACs(new oral anticoagulants ) for stroke prevention in NVAF(Non valvular Atrial Fibrillation) patients including those with renal impairment
Time frame: 6 years
Dose posology
DOACs for stroke prevention in NVAF patients including those with renal impairment
Time frame: 6 years
Naive status and Non-naive status
DOACs for stroke prevention in NVAF patients including those with renal impairment
Time frame: 6 years
Treatment Duration
DOACs for stroke prevention in NVAF patients including those with renal impairment
Time frame: 6 years
Time-trends
Characteristics of first-time use of DOACs in NVAF patients
Time frame: 6 years
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