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Predictors of new oral anticoagulant drug initiation as opposed to warfarin in elderly adults: a retrospective observational study in Southern Italy

Authors Guerriero F, Orlando V, Monetti VM, Colaccio FM, Sessa M, Scavone C, Capuano A, Menditto E

Received 17 April 2018

Accepted for publication 10 June 2018

Published 8 October 2018 Volume 2018:14 Pages 1907—1914


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Garry Walsh

Francesca Guerriero,1,* Valentina Orlando,1,* Valeria Marina Monetti,1 Francesca Maria Colaccio,2 Maurizio Sessa,3,4 Cristina Scavone,3 Annalisa Capuanom3,* Enrica Menditto1,*

1Center of Pharmacoeconomics (CIRFF), University of Naples Federico II, Naples, Italy; 2Caserta Local Health Unit, Caserta, Italy; 3Department of Experimental Medicine, Section of Pharmacology, Regional Center of Pharmacovigilance, University of Campania “L. Vanvitelli”, Naples, Italy; 4Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, DK, Denmark

*These authors contributed equally to this work

The aim of this study was to assess the predictive role of age, gender, and number and type of co-treatments for new oral anticoagulant (NOAC) vs warfarin prescription in elderly patients naïve for the aforementioned drugs.
Materials and methods: Data collected in the period from January 1, 2014, to December 31, 2014, in Caserta Local Health Unit administrative databases (Campania Region, Italy) were screened to identify new users of oral anticoagulants (OACs) who were 75 years or older and whose OAC prescriptions amounted to >90 days of treatment. Age, gender, and number and type of concomitant medications at the time of first OAC dispensation were retrieved. Multivariable logistic regression analysis was used to assess the role of the aforementioned predictors for NOAC initiation as opposed to warfarin.
Results: Overall, 2,132 incident users of OAC were identified, of whom 967 met all inclusion criteria. In all, 490 subjects (50.7%) received an NOAC and 477 (49.3%) received warfarin. Age >75 years was positively associated with lower odds of NOAC initiation (OR: 0.969, 95% CI: 0.941–0.998, P=0.038). Similarly, multiple concomitant medication was negatively associated with NOAC initiation compared to warfarin (OR [five to nine drugs] group: 0.607, 95% CI: 0.432–0.852, P=0.004; OR [ten+ drugs] group: 0.372, 95% CI: 0.244–0.567, P<0.001). Prior exposure to platelet aggregation inhibitor drugs was associated with the initiation of NOACs (OR: 3.474, 95% CI: 2.610–4.625).
Conclusion: Age and multiple co-medication were negatively associated with NOAC initiation.

Keywords: retrospective databases, real-world data, atrial fibrillation, oral anticoagulation, drug utilization

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