Cardiovascular Disease |

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

Mark Malesker, PharmD; Dayla Boldt, PharmD; Hua Ling, PharmD; Tammy Burns, PharmD; Daniel Hilleman, PharmD
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Creighton University, Omaha, NE

Chest. 2013;144(4_MeetingAbstracts):161A. doi:10.1378/chest.1701939
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SESSION TITLE: Cardiovascular Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

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.

CLINICAL IMPLICATIONS: The appropriate utilization of D based upon AT9 would impact approximately one-third of patients with AF requiring anticoagulation.

DISCLOSURE: Daniel Hilleman: Consultant fee, speaker bureau, advisory committee, etc.: AbbVie, Consultant fee, speaker bureau, advisory committee, etc.: AstraZeneca, Consultant fee, speaker bureau, advisory committee, etc.: BristolMyersSquibb, Consultant fee, speaker bureau, advisory committee, etc.: Janssen, Consultant fee, speaker bureau, advisory committee, etc.: Pfizer, Consultant fee, speaker bureau, advisory committee, etc.: Cornerstone Therapeutics, Grant monies (from industry related sources): Gilead The following authors have nothing to disclose: Mark Malesker, Dayla Boldt, Hua Ling, Tammy Burns

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