Clinical Pre-test of a Computerised Antithrombotic Risk Assessment Tool for Stroke Prevention in Atrial Fibrillation: giving consideration to NOACs — The Association Specialists
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Clinical Pre-test of a Computerised Antithrombotic Risk Assessment Tool for Stroke Prevention in Atrial Fibrillation: giving consideration to NOACs (296)

Yishen Wang 1 , Beata V. Bajorek 1 2
  1. Graduate School of Health-Pharmacy, The University of Technology Sydney, Sydney, NSW, Australia
  2. Pharmacy , Royal North Shore Hospital, Sydney, NSW, Australia

Background
In view of the recent availability of the novel anticoagulants (NOACs - dabigatran, rivaroxaban, apixaban) for stroke prevention in atrial fibrillation (AF), decision-making regarding the selection of appropriate therapy has become more complex. Decision support tools, such as the Computerised Antithrombotic Risk Assessment Tool (CARAT), must now consider the NOACs as valid treatment alternatives, and their ability to efficiently make treatment recommendations assessed.


Aims
The objective of this study was to pre-test a modified tool (CARATV2.0), and identify treatment recommendations in a cohort of elderly patients.


Methods
CARATV2.0 was applied to data pertaining to a cohort of 369 patients (mean age 78.01(± 7.01) years; 45.3% female) from a previous study of stroke prevention in AF in the Australian General Practice setting (four Divisions of General Practice, NSW).


Results
For stroke risk, 28(7.9%) patients were categorized as low, 109 (29.5%) moderate, and 231(62.6%) high risk. For bleeding risk, 5(1.4%) patients were categorized as low, 317 (85.9%) intermediate, and 47(12.7%) high risk. Overall, 339 (91.9%) patients were recommended warfarin therapy by the tool, 4 (1.1%) dabigatran, 13 (3.5%) rivaroxaban, 1 (0.3%) apixaban, 2 (0.5%) aspirin, and 10 (2.7%) nil therapy. Among those high bleeding risk, in most (99.5%), patients warfarin was still preferentially recommended as the first-line therapy. Among the 42 patients who were already taking dabigatran, 41 were recommended warfarin therapy by the tool, whilst 1 was recommended rivaroxaban. The most common reasons for changing from warfarin to a NOAC included: known warfarin allergy, prior intracranial bleeding, and previous gastrointestinal bleeding. Overall, 97 (26%) patients were recommended a change in their current therapy.


Conclusions
According to decision-making tools, warfarin appears to still be recommended as first line therapy, despite the availability of NOACs. This provides some insight into the potential scope of use of the NOACs, when taking risk versus benefit profiles into account.