Underutilization of warfarin for stroke prophylaxis in patients with atrial fibrillation or atrial flutter in Korea

Lee, Iyn-Hyang; Kim, Hyun-Ah; Je, Nam Kyung

doi:10.1016/j.jjcc.2015.06.013

Cited by 20 publications

(33 citation statements)

References 48 publications

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“…female gender, vascular disease, and prior ICH, were associated with non-use of OAC therapy in the NOAC era. Previous studies have reported on the underuse of OAC therapy in female patients with AF in accordance with our results [ 3 , 5 , 13 , 25 ]. The reason of OAC underuse in females was not fully understood, but in the VKA era, female gender was a risk factor for poorer anticoagulation control as assessed by time in the therapeutic range of the INR [ 27 ].…”

Section: Discussionsupporting

confidence: 93%

“…Few reports on OAC use for stroke prevention are available for the Korean AF population. Lee et al reported OAC underuse in patients with AF and CHADS 2 score ≥ 2 and ATRIA bleeding risk score ≤ 4 using the National Patients Sample database of 2009 (n = 8,475) [ 5 ]. OAC use and antithrombotic therapy, including OAC and aspirin use, were estimated at 36.0% and 79.6%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…A meta-analysis of the historical randomized trials showed that VKAs effectively reduced the risk of stroke by 64% and mortality by 26% compared to placebo or control [ 2 ]. Despite the clear evidence of benefits, VKAs are underused in a large number of patients with AF who need OACs, for several reasons [ 3 – 5 ]. The narrow therapeutic range and the need for frequent monitoring and dose adjustments, as well as diet and drug interactions made clinicians and patients reluctant to use VKAs [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Temporal trends of antithrombotic therapy for stroke prevention in Korean patients with non-valvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants: A nationwide population-based study

Lee¹,

Choi²,

Han³

et al. 2017

PLoS ONE

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BackgroundFollowing their introduction, the non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly prescribed in Asia for stroke prevention in patients with non-valvular atrial fibrillation (AF). Few contemporary data are available on temporal trends in antithrombotic therapy use in Asian countries, in the era of NOACs.Methods and resultsUsing the National Health Insurance Service database of the entire Korean adult AF population, the use of aspirin, vitamin K antagonist, and NOACs between 2008 and 2015 were analyzed (n = 276,246 in 2015). Most of the included cohort had CHA2DS2-VASc score ≥ 2 (78.2% in 2008 and 83.2% in 2015), yet approximately 17% were prescribed no antithrombotic therapy throughout the study period. Aspirin prescription consistently decreased (from 48.2% to 31.5%) over time, while OAC prescription significantly increased from 34.7% to 50.6%. NOAC prescriptions accounted for 50% of total OAC prescription in 2015. Similar trends in antithrombotic therapy were found both in men and in women, but women were more likely to be undertreated with OAC. Female gender, presence of vascular disease and prior intracranial hemorrhage were associated with OAC underuse.ConclusionsBetween 2008 and 2015, a greater proportion of AF patients received OAC treatment with increasing NOAC prescription trends in the recent 3 years. A substantial proportion (approx. 50%) of Korean patients with AF still remain undertreated.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Temporal trends of antithrombotic therapy for stroke prevention in Korean patients with non-valvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants: A nationwide population-based study

Lee¹,

Choi²,

Han³

et al. 2017

PLoS ONE

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“…Although there are clear benefits of OAC therapy for stroke prevention in high-risk AF patients, OAC is still underused in many patients with AF, particularly in the warfarin era. 12,[45][46][47] The narrow therapeutic range, needs of frequent monitoring/dose adjustments, and interactions with food or drug have made physicians and patients reluctant to use warfarin. 45 The landscape of stroke prevention in AF patients changed with the availability of NOACs.…”

Section: Ischemicmentioning

confidence: 99%

Prevalence of Atrial Fibrillation in Korean Population

Lee

Choi

2017

Int J Arrhythm

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Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice and has been a major public health problem. The prevalence of AF globally has been reported to range from 0.4% to 2% in the adult population; however, the prevalence widely varies depending on the study population. Although AF prevalence in Asian population is about 1% lower than that in European and North American population, the number of AF patients in Asia is rapidly increasing concomitant with the increased aging of the population. However, previous studies that reported AF epidemiology in the Korean population are limited. According to a recent report based on the national health claims database, prevalence of AF in 2015 was 0.7% in the entire Korean adult population and showed a continuous increase with population aging. Additionally, among patients with AF, mean CHA2DS2-VASc score was significantly increased and the number of high thromboembolic risk patients has increased over time. Although oral anticoagulation (OAC) prescription in AF patients increased from 35% to 51%, especially after introduction of non-vitamin K antagonist anticoagulants, a substantial proportion of Korean patients with AF still remain undertreated. In this review, we aimed to summarize temporal changes in the prevalence and incidence of AF and to evaluate the thromboembolic risk in patients with AF. In addition, we also discussed the utilization of OAC therapy in patients with AF in Korean population.

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“… 27) Although recent guidelines recommend the use of OAC therapy in AF patients with a CHA 2 DS 2 -VASc score ≥2, these drugs have been generally underused for stroke prevention. 11) 28) 29) Previous studies performed in a Korean population have reported that female sex, old age, and Medical Aid beneficiaries are common predictors for OAC underutilization. 28) 29) Several reports have discussed the role of SES in determining the choice of antithrombotic therapy for stroke prevention in AF patients.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Non-valvular Atrial Fibrillation Based on Geographical Distribution and Socioeconomic Status in the Entire Korean Population

et al. 2018

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Background and ObjectivesPrevalence of atrial fibrillation (AF) varies based on geographical location and socioeconomic status. We aimed to evaluate the prevalence of AF and utilization of antithrombotic therapy based on geographical regions and income levels in the entire Korean population.MethodsWe performed a cross-sectional analysis of Korean adults (aged ≥20 years) using the 2015 National Health Insurance Service database (n=41,505,679). The study population was stratified into 17 geographical regions and 21 income levels.ResultsWe identified 276,842 patients diagnosed with AF. Overall prevalence of AF in suburban/rural regions was significantly higher than that observed in urban regions (0.72% vs. 0.61%, respectively, p<0.001). Elderly patients (age ≥75 years) showed a higher prevalence of AF and comorbidities related to AF development showed a higher prevalence among the population residing in suburban/rural regions. Among AF patients with a CHA2DS2-VASc score ≥2, oral anticoagulation (OAC) therapy utilization was lower in the suburban/rural regions than that observed in the urban regions (48.2% vs. 51.8%, respectively, p<0.001). The relationship between income levels and AF prevalence showed a J-shaped curve. The OAC prescription rate showed a positive correlation with income levels. Non-vitamin K antagonist oral anticoagulants tended to be more commonly prescribed among the higher income groups.ConclusionsGeographical location of residence and income levels were closely associated with the prevalence of AF and antithrombotic therapy utilization. This information may provide further insights for more effective surveillance of AF and stroke prevention for improved clinical outcomes.

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Underutilization of warfarin for stroke prophylaxis in patients with atrial fibrillation or atrial flutter in Korea

Abstract: A high portion of AF/AFL patients with CHADS2 score ≥2 were undertreated with warfarin. As ischemic stroke is one of the leading causes of death in Korea, a more aggressive approach to prevent stroke in patients with AF/AFL is required.

Cited by 20 publications

References 48 publications

Temporal trends of antithrombotic therapy for stroke prevention in Korean patients with non-valvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants: A nationwide population-based study

Temporal trends of antithrombotic therapy for stroke prevention in Korean patients with non-valvular atrial fibrillation in the era of non-vitamin K antagonist oral anticoagulants: A nationwide population-based study

Prevalence of Atrial Fibrillation in Korean Population

Prevalence of Non-valvular Atrial Fibrillation Based on Geographical Distribution and Socioeconomic Status in the Entire Korean Population

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