Clinical pre-test of a computerised antithrombotic risk assessment tool for stroke prevention in atrial fibrillation patients: giving consideration to NOACs.
OBJECTIVE
The decision-making around antithrombotics in atrial fibrillation requires comprehensive risk versus benefit assessment. In view of the availability of novel oral anticoagulants (NOACs) including dabigatran, rivaroxaban and apixaban, a decision support tool designed to assist the selection of antithrombotics has been modified to consider both warfarin and NOACs. This study aims to pre-test this modified decision support tool.


METHODS
The decision support tool was modified to consider either warfarin or NOACs as first-line therapy and applied to data pertaining to a cohort of 393 patients in New South Wales.


RESULTS
Overall, 380 (96.7%) patients were eligible for oral anticoagulants. In the scenario of warfarin being recommended as first-line therapy, the Computerised Antithrombotic Risk Assessment Tool version 2.0 (caratv2.0) recommended warfarin for 360 (91.6%) patients, any NOAC for 5 (1.3%) patients, either rivaroxaban or apixaban for 6 (1.5%) patients and apixaban for 9 (2.2%) patients. In the scenario of NOACs as first-line therapy, caratv2.0 recommended any NOAC for 279 (70.9%) patients, either rivaroxaban or apixaban for 80 (20.4%) patients, apixaban for 9 (2.3%) patients and warfarin for 12 (3.1%) patients. Key reasons for caratv2.0 to recommend a change from warfarin (patients' current therapy) to NOACs included known warfarin allergy/adverse reaction, a history of intracranial bleeding, and previous gastrointestinal bleeding. Key predictors for caratv2.0 to consider that patients are more suitable for NOACs over warfarin were a diagnosis of other gastrointestinal diseases, more co-morbidities and high risk of falls.


CONCLUSIONS
According to this decision support tool, both warfarin and NOACs are viable treatment options in majority of the patients, but there is a scope for better rationalization of therapy.
Graduate School of Health - Pharmacy, University of Technology Sydney, Sydney, NSW, Australia.
Yishen
Y
Wang
Graduate School of Health - Pharmacy, University of Technology Sydney, Sydney, NSW, Australia.|Department of Pharmacy, Royal North Shore Hospital, Sydney, NSW, Australia.
Beata
B
Bajorek
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D008297:Male; D018570:Risk Assessment; D012984:Software; D020521:Stroke / Q000517:prevention & control*; D013927:Thrombosis / Q000188:drug therapy* / Q000517:prevention & control*
D000925:Anticoagulants
atrial fibrillation; computer-assisted; decision making; decision support; novel oral anticoagulant; stroke prevention; warfarin