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How do doctors choose to prescribe NOACs vs VKAs for stroke prevention?

19 Jun 2019

The choice between nonvitamin K antagonist oral anticoagulants (NOACs) or vitamin K antagonists (VKAs) for stroke prevention appears to be complex and largely heterogenous across different, countries, a new study has found.

In the 24,137 patients whose records were reviewed, NOACs (n=12,395; 51.4 percent; median age, 72.0 years) had been the medication of choice, though not by a big margin over VKAs (n=11,742; 48.6 percent; median age, 71.0 years). Logistic least absolute shrinkage and selection operator (LASSO) regression was performed to determine predictors of NAOC or VKA use.

Prescription trends of NOACs varied greatly across the 35 countries included in the analysis, ranging from 6.1 percent (of all patients who were given anticoagulants) in Thailand to 87.5 percent in Switzerland. Country of enrolment emerged as the strongest predictor of anticoagulants.

Excluding the country variable, the year of enrolment was found to be the next most influential factor, followed by the setting in which patients were enrolled. Notably, the participants’ clinical and demographic characteristics were consistently the least important factors in anticoagulant choice.

In comparison, LASSO revealed that patients presenting to the emergency care (odds ratio [OR], 1.16, 95 percent CI, 1.04–1.30) or outpatient (OR, 1.15, 1.05–1.25) setting were significantly more likely to be prescribed NOACs than VKAs as a first-line treatment for stroke prevention as opposed to patients who had been admitted into the hospital.

Factors that were predictive of NOAC prescriptions included year of enrolment, increasing age and acute coronary syndrome. On the other hand, having moderate-to-severe kidney disease, heart failure and diabetes were significantly associated with VKA prescriptions.

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Most Read Articles
Elaine Soliven, 4 days ago

Switching from efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF) to the new bictegravir/ emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) regimen maintained high rates of virological suppression in adults who are living with HIV*, according to a study presented at AIDS 2020.

2 days ago
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Stephen Padilla, 4 days ago
Pre-exposure prophylaxis (PrEP) containing either long-acting injectable cabotegravir (CAB) or tenofovir/emtricitabine (TDF/FTC) is safe and effective for transgender women (TGW) and cisgender men who have sex with men (MSM), but CAB results in a much lower HIV incidence compared to TDF/FTC, results of the HIV Prevention Trials Network (HPTN) 083 have shown.
Jairia Dela Cruz, 3 days ago
Monthly prophylaxis with the fixed-dose combination of naphthoquine-azithromycin (NQAZ) is well tolerated and confers significant protection against infection with Plasmodium parasites among individuals residing in malaria-endemic areas in Southeast Asia, as shown in the results of a phase III trial.