Category: Federal Forum Posters
Purpose: Anticoagulation is the cornerstone of therapy for patients with atrial fibrillation, venous thromboembolism and pulmonary thromboembolism. Warfarin has traditionally been the therapy of choice for patients requiring outpatient anticoagulation, however, direct oral anticoagulants (DOACs) are gaining popularity. As of June 2018 there were 985 patients on warfarin and 1163 patients on DOAC therapy under the care of the VA Maine Healthcare System. Apixaban accounts for ~70% of all DOACs prescribed at VA Maine. The purpose of this research project is to determine the safety profile of apixaban versus warfarin in patients enrolled in the VA Maine Healthcare System Anticoagulation Clinic.
Methods: This study will be submitted to the Institutional Review Board for approval. The VA electronic medical record system will be used to identify veterans who received at least six months of outpatient anticoagulant therapy with warfarin or apixaban from 07/01/17 to 06/30/18 by refill history. From that report, 150 patients on warfarin and 150 patients on apixaban will be selected and baseline characteristics will be recorded. The Anticoag Event Health Factor (from the VA’s VISN 1 reporting database) will be utilized to identify the occurrence of the primary safety outcome in patients being analyzed. This outcome includes incidence of major bleeding (fatal bleeding, symptomatic bleeding in a critical area of organ, bleeding causing a fall in hemoglobin level of 20 g/L or more leading to transfusion of two or more units of whole blood or red cells, or bleeding events which required hospitalization). A secondary analysis will investigate the rate of symptomatic thrombotic events (thromboembolism and cardiovascular accident). Events reported from the VA Maine Healthcare System will be analyzed from anticoagulation initiation to the present per patient being investigated. Incidence rates will be compared between groups utilizing a Chi squared test and reported as event per days of therapy.
Results: not applicable
Conclusion: not applicable
Whitney Sargent– Pharmacy Resident, VA Maine Healthcare System, Augusta, ME