The prevalence of using direct oral anticoagulants (DOACs) versus warfarin in atrial fibrillation at King Abdullah Medical City (KAMC) in Makkah, Saudi Arabia

Introduction: Atrial fibrillation is an irregular and can be a very rapid heart rate disorder. It is a type of arrhythmia that increases the risk of stroke and associated with increasing the risk of heart failure and all-cause mortality. Warfarin has been commonly prescribed in the treatment and prevention of different thromboembolic conditions including the atrial fibrillation. However, in recent years, several new oral anticoagulant medications with a direct and reversible inhibitory effect on the enzymatic activity of thrombin (dabigatran) or factor Xa (apixaban and rivaroxaban) in the coagulation cascade have been developed and approved by the FDA as an equivalent to warfarin or even more effective. We are doing this study to show the prevalence of those three drugs compared to warfarin and to estimate the patient's eligibility for using warfarin compared to the new oral anticoagulants. Method: Retrospective study, at Cardiology department at King Abdullah Medical city (KAMC) in Makkah. Result: We screened a total of 267 patients, out of 144 patients who were taking DOACs, 97 (74.6%) were included. And out of 123 patients who were taking warfarin, 33 (25.4%) of them were included. Patients were excluded because they don't have the right diagnosis, or do not have INR or serum creatinine results. Pregnant and lactating women were also excluded. Conclusion: Since FDA approval, apixaban and dabigatran use in AF has increased dramatically compared to warfarin which was diminished. In patients with AF, risks of stroke/SE and major bleeding were lower with DOACs versus warfarin. However, it is vital to perform continuous monitoring of these medication effectiveness.