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ObjectivesThis study aims to investigate US active duty (AD) military members diagnosed with atrial fibrillation (AF) and the temporal trends of systemic anticoagulation (AC). Our secondary objective is to study the AC prescriptions in AD military members diagnosed with AF and associated military dispositions and deployment rates.

Design and Setting: A retrospective investigation of Tricare pharmacy AC prescriptions within the San Antonio Military Health System from January 2004 to July 2019 for AD individuals diagnosed with AF was performed.

Participants: 386 AD personnel with non-valvular AF were analysed (mean age 35.0±9.4 years; mean body mass index, 28.3±4.3 kg/m 2 ; 93% male; 57% Caucasian, 94% paroxysmal AF).

Outcomes: The temporal trends of systemic AC prescriptions were the primary outcome measures. The association between AC prescriptions and military dispositions and deployments were secondary outcomes of interest.

Statistical Analysis: The association between AC management, future deployments and military disposition was analysed using χ 2 and Fisher's exact test for categorical variables. The t-test was used for comparison of continuous variables.

Results: CHA 2 DS 2 -VASc and HAS-BLED scores were low (0.39±0.65 and 0.86±0.63, respectively). 127 (33%) members received warfarin and 58 (15%) received direct oral anticoagulants (DOACs). Rates of military retention were not different between AC histories (no AC (64%) vs warfarin (75%) vs DOAC (65%); p=0.425). There was a significant trend of more recent utilisation of DOACs compared with warfarin (p<0.0001). When adjusted for temporal changes in deployment rates, there was no significant difference in deployment between AC groups (no AC (39%) vs warfarin (49%) vs DOAC (27%); p=0.9472).

Conclusions: This is the first report describing AC utilisation in US AD military members with AF. Young AD personnel with low stroke and bleeding risks do not commonly receive AC prescriptions. DOAC prescription rates are increasing and predominate over warfarin for AC indications.

Competing Interests: Competing interests: None declared.

Titel:	Temporal trends in anticoagulation management for US active duty personnel with atrial fibrillation.
Autor/in / Beteiligte Person:	Keithler, AN ; Wilson, AS ; Yuan, A ; Sosa, JM ; Bush, KNV
Link:	Full Text Finder (Volltext)
Zeitschrift:	BMJ open, Jg. 12 (2022-11-29), Heft 11, S. e049394
Veröffentlichung:	[London] : BMJ Publishing Group Ltd, 2011-, 2022
Medientyp:	academicJournal
ISSN:	2044-6055 (electronic)
DOI:	10.1136/bmjopen-2021-049394
Schlagwort:	Male Humans Adult Female Warfarin therapeutic use Retrospective Studies Anticoagulants therapeutic use Atrial Fibrillation drug therapy Military Personnel
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [BMJ Open] 2022 Nov 29; Vol. 12 (11), pp. e049394. <i>Date of Electronic Publication: </i>2022 Nov 29. MeSH Terms: Atrial Fibrillation* / drug therapy ; Military Personnel* ; Male ; Humans ; Adult ; Female ; Warfarin / therapeutic use ; Retrospective Studies ; Anticoagulants / therapeutic use References: J Am Heart Assoc. 2019 Sep 3;8(17):e012646. (PMID: 31441364) ; Heart Rhythm. 2011 Mar;8(3):e1-8. (PMID: 21324421) ; J R Army Med Corps. 2015 Sep;161(3):237-43. (PMID: 26246351) ; J Am Coll Cardiol. 2019 Jul 9;74(1):104-132. (PMID: 30703431) ; Hosp Pharm. 2018 Oct;53(5):286-291. (PMID: 30210144) ; J Atr Fibrillation. 2015 Dec 31;8(4):1309. (PMID: 27957228) ; Aviat Space Environ Med. 2013 Dec;84(12):1249-54. (PMID: 24459795) ; Circ Res. 2017 Apr 28;120(9):1501-1517. (PMID: 28450367) ; N Engl J Med. 2011 Sep 15;365(11):981-92. (PMID: 21870978) ; J Am Coll Cardiol. 2006 Aug 15;48(4):854-906. (PMID: 16904574) ; Circulation. 2014 Dec 2;130(23):e199-267. (PMID: 24682347) ; J Am Coll Cardiol. 2001 Oct;38(4):1231-66. (PMID: 11583910) ; J Am Coll Cardiol. 2017 May 23;69(20):2475-2484. (PMID: 28521884) ; N Engl J Med. 2011 Sep 8;365(10):883-91. (PMID: 21830957) ; Am J Epidemiol. 2018 Mar 1;187(3):417-426. (PMID: 28641376) ; Curr Treat Options Cardiovasc Med. 2019 Dec 10;21(12):85. (PMID: 31820122) ; Am J Med. 2015 Dec;128(12):1300-5.e2. (PMID: 26144101) ; N Engl J Med. 2009 Sep 17;361(12):1139-51. (PMID: 19717844) ; Lancet. 2014 Mar 15;383(9921):955-62. (PMID: 24315724) ; JAMA. 2019 Apr 2;321(13):1261-1274. (PMID: 30874766) ; Clin Epidemiol. 2013 Dec 09;5:475-81. (PMID: 24353441) Contributed Indexing: Keywords: AVIATION MEDICINE; Adult cardiology; Cardiology; Pacing & electrophysiology Substance Nomenclature: 5Q7ZVV76EI (Warfarin) ; 0 (Anticoagulants) Entry Date(s): Date Created: 20221129 Date Completed: 20221201 Latest Revision: 20221208 Update Code: 20240513 PubMed Central ID: PMC9710344

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Temporal trends in anticoagulation management for US active duty personnel with atrial fibrillation.