title: Novel Oral Anticoagulant Use Among Patients With Atrial Fibrillation Hospitalized With Ischemic Stroke or Transient Ischemic Attack.
abstract: BACKGROUND
  Novel oral anticoagulants (NOACs) have been shown to be at least as good as warfarin for preventing stroke or transient ischemic attack in patients with atrial fibrillation, yet diffusion of these therapies and patterns of use among atrial fibrillation patients with ischemic stroke and transient ischemic attack have not been well characterized.
  
  
  RESULTS
  Using data from Get With The Guidelines-Stroke, we identified a cohort of 61 655 atrial fibrillation patients with ischemic stroke or transient ischemic attack hospitalized between October 2010 and September 2012 and discharged on warfarin or NOAC (either dabigatran or rivaroxaban). Multivariable logistic regression was used to identify factors associated with NOAC versus warfarin therapy. In our study population, warfarin was prescribed to 88.9%, dabigatran to 9.6%, and rivaroxaban to 1.5%. NOAC use increased from 0.04% to a 16% to 17% plateau during the study period, although anticoagulation rates among eligible patients did not change appreciably (93.7% versus 94.1% from first quarter 2011 to second quarter 2012), suggesting a trend of switching from warfarin to NOACs rather than increased rates of anticoagulation among eligible patients. Several bleeding risk factors and CHA2DS2-VASc scores were lower among those discharged on NOAC versus warfarin therapy (47.9% versus 40.9% with CHA2DS2-VASc ≤5, P<0.001 for difference in CHA2DS2-VASc).
  
  
  CONCLUSIONS
  NOACs have had modest but growing uptake over time among atrial fibrillation patients hospitalized with stroke or transient ischemic attack and are prescribed to patients with lower stroke risk compared with warfarin.
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., X.Z., B.L.L., Y.X., E.D.P., A.F.H.); Ronald-Reagan University of California, Los Angeles Medical Center, UCLA Department of Medicine, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Brigham and Women's Hospital (D.L.B.) and Massachusetts General Hospital (L.H.S.), Harvard Medical School, Boston, MA; and Duke University Medical Center, Durham, NC (E.D.P., A.F.H.). priyesh.patel@dm.duke.edu.
authors.forename: Priyesh A
authors.initials: PA
authors.lastname: Patel
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., X.Z., B.L.L., Y.X., E.D.P., A.F.H.); Ronald-Reagan University of California, Los Angeles Medical Center, UCLA Department of Medicine, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Brigham and Women's Hospital (D.L.B.) and Massachusetts General Hospital (L.H.S.), Harvard Medical School, Boston, MA; and Duke University Medical Center, Durham, NC (E.D.P., A.F.H.).
authors.forename: Xin
authors.initials: X
authors.lastname: Zhao
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., X.Z., B.L.L., Y.X., E.D.P., A.F.H.); Ronald-Reagan University of California, Los Angeles Medical Center, UCLA Department of Medicine, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Brigham and Women's Hospital (D.L.B.) and Massachusetts General Hospital (L.H.S.), Harvard Medical School, Boston, MA; and Duke University Medical Center, Durham, NC (E.D.P., A.F.H.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., X.Z., B.L.L., Y.X., E.D.P., A.F.H.); Ronald-Reagan University of California, Los Angeles Medical Center, UCLA Department of Medicine, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Brigham and Women's Hospital (D.L.B.) and Massachusetts General Hospital (L.H.S.), Harvard Medical School, Boston, MA; and Duke University Medical Center, Durham, NC (E.D.P., A.F.H.).
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Lytle
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., X.Z., B.L.L., Y.X., E.D.P., A.F.H.); Ronald-Reagan University of California, Los Angeles Medical Center, UCLA Department of Medicine, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Brigham and Women's Hospital (D.L.B.) and Massachusetts General Hospital (L.H.S.), Harvard Medical School, Boston, MA; and Duke University Medical Center, Durham, NC (E.D.P., A.F.H.).
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., X.Z., B.L.L., Y.X., E.D.P., A.F.H.); Ronald-Reagan University of California, Los Angeles Medical Center, UCLA Department of Medicine, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Brigham and Women's Hospital (D.L.B.) and Massachusetts General Hospital (L.H.S.), Harvard Medical School, Boston, MA; and Duke University Medical Center, Durham, NC (E.D.P., A.F.H.).
authors.forename: Ying
authors.initials: Y
authors.lastname: Xian
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., X.Z., B.L.L., Y.X., E.D.P., A.F.H.); Ronald-Reagan University of California, Los Angeles Medical Center, UCLA Department of Medicine, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Brigham and Women's Hospital (D.L.B.) and Massachusetts General Hospital (L.H.S.), Harvard Medical School, Boston, MA; and Duke University Medical Center, Durham, NC (E.D.P., A.F.H.).
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., X.Z., B.L.L., Y.X., E.D.P., A.F.H.); Ronald-Reagan University of California, Los Angeles Medical Center, UCLA Department of Medicine, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Brigham and Women's Hospital (D.L.B.) and Massachusetts General Hospital (L.H.S.), Harvard Medical School, Boston, MA; and Duke University Medical Center, Durham, NC (E.D.P., A.F.H.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., X.Z., B.L.L., Y.X., E.D.P., A.F.H.); Ronald-Reagan University of California, Los Angeles Medical Center, UCLA Department of Medicine, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Brigham and Women's Hospital (D.L.B.) and Massachusetts General Hospital (L.H.S.), Harvard Medical School, Boston, MA; and Duke University Medical Center, Durham, NC (E.D.P., A.F.H.).
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (P.A.P., X.Z., B.L.L., Y.X., E.D.P., A.F.H.); Ronald-Reagan University of California, Los Angeles Medical Center, UCLA Department of Medicine, Los Angeles, CA (G.C.F.); Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Brigham and Women's Hospital (D.L.B.) and Massachusetts General Hospital (L.H.S.), Harvard Medical School, Boston, MA; and Duke University Medical Center, Durham, NC (E.D.P., A.F.H.).
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: anticoagulants; anticoagulation; atrial fibrillation; ischemic attack; stroke; transient