Survey of the use of warfarin and the newer anticoagulant dabigatran in patients with atrial fibrillation

Background: Oral dabigatran was recently approved as an alternative to warfarin for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Unlike warfarin, dabigatran has a fixed dosage and few drug interactions, and does not require anticoagulation monitoring or dietary restrictions.

Methods: This study aimed to describe and compare characteristics of patients with atrial fibrillation who used dabigatran or only warfarin. Patients with a self-reported diagnosis of atrial fibrillation aged ≥18 years who were receiving (or had received) warfarin or dabigatran completed an online survey. Differences in characteristics of dabigatran and warfarin users were tested using chi-squared tests and analysis of variance for categorical and continuous variables, respectively.

Results: Overall, 364 patients were surveyed (204 warfarin users, 160 dabigatran users). The mean age was 65.1 years, and 68.7% were male. Dabigatran users were more likely than warfarin users to be female (36.9% versus 27.0%) and to have experienced adverse events, including gastrointestinal bleeding, in the 3 months before the survey (21.9% versus 6.9%; P<0.05). Both groups reported high medication adherence (dabigatran users 0.65 versus warfarin users 0.63 missed doses/month). Dabigatran users were more likely than warfarin users to discuss treatment options with their physician before beginning therapy (36.9% versus 24.5%; P<0.05) and less likely to switch anticoagulant medication (10.7% versus 31.9%; P<0.05). Although dabigatran users were more likely to experience adverse events, they reported greater satisfaction with anticoagulation treatment than warfarin users.

Conclusion: The efficacy and convenience reported by dabigatran users resulted in greater treatment satisfaction among dabigatran users, even though adverse events decreased it. Treatment strategies that minimize adverse events may improve treatment satisfaction and adherence among patients with atrial fibrillation.