Early adoption of dabigatran and its dosing in US patients with atrial fibrillation: results from the outcomes registry for better informed treatment of atrial fibrillation.
Abstract
BACKGROUND: Dabigatran is a novel oral anticoagulant approved for thromboprophylaxis
in atrial fibrillation. Adoption patterns of this new agent in community practice
are unknown. METHODS AND RESULTS: We studied patterns of dabigatran use among patients
enrolled in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation
(ORBIT-AF) Registry between June 2010 and August 2011 and followed for 12 months.
Among 9974 atrial fibrillation patients included, 1217 (12%) were treated with dabigatran
during the study. Overall, patients receiving dabigatran were younger (median age
72 versus 75 years, P<0.0001), more likely to be white (92% versus 89%, P=0.005),
more likely to have private insurance (33% versus 25%, P<0.0001), and less likely
to have prior cardiovascular disease (4% versus 33%, P<0.0001). They had more new-onset
atrial fibrillation (8.8% versus 4.1%, P<0.0001), lower CHADS2 scores (estimated risk
based on the presence of congestive heart failure, hypertension, aged ≥75 years, diabetes
mellitus, and prior stroke or transient ischemic attack; mean 2.0 versus 2.3, P<0.0001),
and lower Anticoagulation and Risk Factors in Atrial Fibrillation scores (mean 2.4
versus 2.8, P<0.0001). More than half (n=14/25, 56%) of patients with severe kidney
disease were not prescribed reduced dosing, whereas 10% (n=91/920) with preserved
renal function received lower dosing. Among patients not on dabigatran at baseline,
8% had dabigatran initiated during follow-up. Patient education was significantly
associated with switching from warfarin to dabigatran (adjusted odds ratio for postgraduate
1.73, P=0.007), whereas antiarrhythmic drug use significantly correlated with de novo
adoption of dabigatran (adjusted odds ratio 2.4, P<0.0001). CONCLUSIONS: Patients
receiving dabigatran were younger and at a lower risk of stroke and bleeding. Patients
appeared to drive switching from warfarin, whereas clinical characteristics influenced
de novo start of dabigatran. These data suggest cautious early uptake of dabigatran,
and more careful attention to dosing adjustments is warranted. CLINICAL TRIAL REGISTRATION
URL: Clinicaltrials.gov. Unique identifier: NCT01165710.
Type
Journal articleSubject
anticoagulantatrial fibrillation
dabigatran
dosing
pharmacoepidemiology
Administration, Oral
Age Factors
Aged
Aged, 80 and over
Anticoagulants
Atrial Fibrillation
Benzimidazoles
Chi-Square Distribution
Comorbidity
Dabigatran
Drug Dosage Calculations
Drug Substitution
Female
Health Knowledge, Attitudes, Practice
Hemorrhage
Humans
Logistic Models
Male
Middle Aged
Odds Ratio
Patient Education as Topic
Practice Patterns, Physicians'
Proportional Hazards Models
Registries
Risk Factors
Socioeconomic Factors
Stroke
Time Factors
Treatment Outcome
United States
beta-Alanine
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https://hdl.handle.net/10161/15012Published Version (Please cite this version)
10.1161/JAHA.113.000535Publication Info
Steinberg, Benjamin A; Holmes, Dajuanicia N; Piccini, Jonathan P; Ansell, Jack; Chang,
Paul; Fonarow, Gregg C; ... Outcomes Registry for Better Informed Treatment of Atrial
Fibrillation (ORBIT-AF) Investigators and Patients (2013). Early adoption of dabigatran and its dosing in US patients with atrial fibrillation:
results from the outcomes registry for better informed treatment of atrial fibrillation.
J Am Heart Assoc, 2(6). pp. e000535. 10.1161/JAHA.113.000535. Retrieved from https://hdl.handle.net/10161/15012.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Eric David Peterson
Fred Cobb, M.D. Distinguished Professor of Medicine
Dr Peterson is the Fred Cobb Distinguished Professor of Medicine in the Division of
Cardiology, a DukeMed Scholar, and the Past Executive Director of the Duke Clinical
Research Institute (DCRI), Durham, NC, USA.
Dr Peterson is the Principal Investigator of the National Institute of Health, Lung
and Blood Institute (NHLBI) Spironolactone Initiation Registry Randomized Interventional
Trial in Heart Failure With Preserved Ejection Fraction (SPIRRIT) Trial He is also
the Principal I
This author no longer has a Scholars@Duke profile, so the information shown here reflects
their Duke status at the time this item was deposited.
Jonathan Paul Piccini Sr.
Professor of Medicine
Jonathan P. Piccini, MD, MHS, FACC, FAHA, FHRS is a clinical cardiac electrophysiologist
and Associate Professor of Medicine with Tenure at Duke University Medical Center
and the Duke Clinical Research Institute. He is the Director of the Cardiac Electrophysiology
section at the Duke Heart Center. His focus is on the care of patients with atrial
fibrillation and complex arrhythmias, with particular emphasis on catheter ablation,
left atrial appendage occlusion, and lead extraction. His resear
Benjamin Steinberg
House Staff
Laine Elliott Thomas
Professor of Biostatistics & Bioinformatics
As Deputy Director, Laine Thomas, PhD provides complementary leadership in strategy
and development of the group and DCRI. She has an outstanding record of scientific
and strategic collaboration, independent research, leadership and mentoring well known
to her colleagues at the DCRI.
Thomas joined the DCRI in 2009. She serves as Associate Director for Biostatistics
at DCRI and Associate Chair for Equity, Diversity and Inclusion within the Department
of
Alphabetical list of authors with Scholars@Duke profiles.

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