PB0020 - Anticoagulation discharge treatment recommendations in patients admitted with a first-time diagnosis of atrial fibrillation

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Orly Efros, MD, MHA (she/her/hers)

Physician, thrombosis and hemostasis specialist
National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Israel. Sackler Faculty of Medicine, Tel Aviv University, Israel.
Rishon Letzion, HaMerkaz, Israel

Co-Author(s)

Omri Cohen, MD

Senior physician
Sheba medical center, Tel Aviv University
Holon, HaMerkaz, Israel
SL

Shadan Lalezari

Physician, thrombosis and hemostasis specialist
National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Israel. Sackler Faculty of Medicine, Tel Aviv University, Israel. Amalia Biron Research Institute of Thrombosis & Hemostasis, Sheba Medical Center, Israel
Ramat Gan, HaMerkaz, Israel
Gili Kenet, MD

Director
The National Hemophilia Center, and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
Yehud-Monosson, HaMerkaz, Israel
AL

Aharon Lubetsky

Director, Thrombosis and Hemostasis Unit
National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Israel. Sackler Faculty of Medicine, Tel Aviv University, Israel.
Ramat Gan, HaMerkaz, Israel
EK

Eyal Klang

Head of the Sami Sagol AI Hub at ARC Innovation
Arc Innovation Center, Sheba Medical Center, Israel. Sackler Faculty of Medicine, Tel Aviv University, Israel.
Ramat Gan, HaMerkaz, Israel
NB

Noam Barda

Head of the Real World Evidence Research and Innovation Lab, ARC Innovation Center
ARC Innovation Center, Sheba Medical Center, Ramat-Gan, Israel. Software and Information Systems Engineering, Ben Gurion University, Be’er Sheva, Israel. 6 Epidemiology, Biostatistics and Community Health Services, Ben-Gurion University of the Negev, Be’er Sheva, Israel.
Ramat Gan, HaMerkaz, Israel

Background: Direct oral anticoagulants (DOACs) and warfarin are the primary therapeutic options for stroke prevention in high-risk patients with atrial fibrillation. With few exceptions, no guidelines exist for the decision of whether to recommend Warfarin or DOACs.

Aims: To evaluate medical recommendations given to inpatients upon discharge following admission for newly diagnosed atrial fibrillation and their rationale.

Methods: We retrieved all patients admitted with a first diagnosed event of atrial fibrillation and discharged with anticoagulant treatment at Sheba Medical Center between January 2014 and January 2023. Patients with a prior atrial fibrillation diagnosis or anticoagulation treatment were excluded. We first compared patients according to the recommended anticoagulation treatment they received upon discharge. We then tested whether any treatment option showed an advantage for one-year mortality using the Kaplan-Meier method and an adjusted Cox model.

Results: A total of 1,295 patients were included. 435 were discharged with Warfarin and 860 with a DOAC. Patients discharged with Warfarin were younger and tended to have a lower proportion of background diseases, such as cancer, diabetes mellitus, and primary hypertension, when compared to patients discharged with DOACs (p-value < 0.05). The mortality risk in the year following discharge was not significantly different between patients discharged with Warfarin and DOACs, as estimated in the crude data using the Kaplan-Meier method (p-value = 0.14). Similar results were seen in the Cox model analysis (Hazard Ratio = 1.07; 95% confidence interval: 0.70–1.62; p-value = 0.79).

Conclusion(s): The study found that physicians tend to prescribe Warfarin for patients newly diagnosed with atrial fibrillation who are younger and have fewer comorbidities. However, neither Warfarin nor DOACs showed an advantage in terms of 1-year mortality rates, raising a question regarding the rationale for this preference.