Abstract 16525: Evaluating The Rate Of Coumadin Prescription In The Era Of Direct Oral Anticoagulants

IntroductionClinical, health economic and quality of life data supports the Direct Oral Anticoagulants (DOAC) over warfarin in patients at risk for thromboembolic events in the setting of non-valvulvar atrial fibrillation (AF). We sought to evaluate the rate and reasons for ongoing use of warfarin in this population.MethodsBaseline, follow up, medication reconciliation and insurance status data for all patients treated with warfarin at a large AF clinic were collected for this analysis. Contraindication to DOAC use were noted for all patients in the cohort. History of cardiovascular, renal, and hepatic disease, as well as the CHA2DS2-VASc score was obtained for all patients. Canadian Cardiovascular Society 2018 guidelines was used to assess treatment appropriateness.Results553 patients treated with warfarin at the time of data collection (August 2018, Mean age76.0±9.6 years, 52% Male, Mean CHA2DS2-VASc score3.5±1.3) were identified and included in this analysis. Of those on warfarin 16% (88) did not have private insurance and were under the age of 65 (no public coverage), 18% (101) had a mechanical valve, 13% (74) had severe renal impairment, 3.4% (19) had a prior major bleeding episode, 10 of which occurred while patient was treated with a DOAC. Remaining 271 (49%) were eligible for treatment with a DOAC.ConclusionHalf of the patients seen at a large atrial fibrillation clinic treated with warfarin as of 2018 had no contraindications to a DOAC, but for reasons related to medication coverage, patient and physician comfort remain on warfarin. This population may derive further benefit from appropriate conversion to a DOAC.