Impact of the ACCP Antithrombotic Guidelines on Potential Utilization of Dabigatran in Patients With Atrial Fibrillation

Abstract

PURPOSE: The American College of Chest Physicians Antithrombotic Guidelines, 9th edition (AT9) recommends dabigatran (D) over warfarin (W) in patients with atrial fibrillation (AF) with certain exceptions. The objective of this study was to determine the proportion of patients eligible to receive D based upon AT9 recommendations in a cohort of patients with AF currently receiving W at an academic medical center. METHODS: Hospitalized patients with AF receiving W admitted during the period from 1/1/11 thru 5/6/12 were evaluated. Patients who would be eligible to receive D based on AT9 recommendations were identified. Reasons for exclusion from D use were tabulated RESULTS: A total of 812 patients were admitted to our hospital with a history of AF and were receiving W. 585 (72%) patients had an exception to the use of D. These included valvular heart disease in 35 (4%), stable coronary artery disease in 298 (37%), first six months after stent placement in 135 (17%), first year after acute coronary syndrome without stenting in 19 (2%), and creatinine clearance less than 30 ml/min in 98 (12%). CONCLUSIONS: Following AT9, D would be considered appropriate in approximately 3 of 10 patients admitted with AF eligible for anticoagulation at our institution. The most common reasons for exclusion from use of D were coronary artery disease, recent stent, and poor renal function.