(P-390) A Contemporary Characterization of Patients with Non-valvular Atrial Fibrillation Starting Oral Anticoagulants in Quebec, Canada

Background: Clinical trials suggest similar efficacy of direct oral anticoagulants (DOACs), compared with warfarin, for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). However, the profile of patients prescribed these drugs in routine practice in Quebec, Canada, has not been well-described.

Objectives: To describe characteristics of patients newly dispensed DOACs or warfarin for NVAF between 2010 and 2016 in the province of Quebec, Canada. To also compare the profile of DOAC users with those included in the three pivotal clinical trials comparing DOACs with warfarin for stroke prevention in NVAF.

Methods: We used the heath administrative databases of the Régie de l’assurance maladie du Québec and MED-ECHO to identify all adult patients with NVAF newly dispensed warfarin, dabigatran, rivaroxaban, or apixaban between January 1, 2010 and December 31, 2016. We compared demographics, comorbidities, medication use, and health care utilization of new DOAC users with those of new warfarin users. In addition, we compared new DOAC users in our cohort to those in the respective dabigatran, rivaroxaban, and apixaban arms of pivotal clinical trials. To ensure comparability with the trials, we included patients with or without prior warfarin use in this analysis.

Results: A total of 61,857 patients started an oral anticoagulant during the study period (34,201 DOACs, 27,656 warfarin); the median age was 77.1 years and 51% were males. Overall, compared with warfarin users, DOAC users were younger (≥75 years: 54 vs 64%), had a lower prevalence of hypertension (74 vs 84%), myocardial infarction (9 vs 18%), heart failure (16 vs 26%), diabetes (26 vs 34%), stroke or transient ischemic attack (8 vs 12%), and chronic kidney disease (9 vs 23%). A lower proportion used ≥10 drug classes (38 vs 49%) and had ≥1 hospitalization (56 vs 72%) in the year before initiation. However, those prescribed apixaban, the more recently approved DOAC, had similar profiles to warfarin users. Compared with patients initiating DOACs in clinical trials, those in our study were older and more frequently women, had less hypertension, myocardial infarction, congestive heart failure, diabetes, and stroke, and were less likely to have prior warfarin use.

Conclusions: In patients with NVAF starting oral anticoagulants, the clinical profile of DOAC users differed from warfarin users and across users of each DOAC. There were also key clinical differences with patients included in clinical trials. However, the clinical profile of patients prescribed DOACs may evolve over time, which warrants future investigation.