Understanding Oral Anticoagulation Across Clinical Settings

Abstract

Oral anticoagulation (OAC) remains the cornerstone of stroke prevention in patients with atrial fibrillation (AF). Some areas of OAC management are well supported, while other areas require further research to inform clinical practise and support guidelines. My thesis focuses on generating knowledge about OAC use in 2 understudied settings: a) the emergency department (ED), and b) after cardiac surgery. Chapter 1 is a preface that provides the rationale for conducting each of the following three chapters. In the ED, physicians are in a unique position to initiate OAC; however, prescription remains low. In the early period after open-heart surgery, initiating OAC is not the main issue, but rather, what class of OAC is the most safe and efficacious. Chapter 2 uses a global registry dataset to explore the clinical patterns that lead to initiating OAC in the ED, along with the factors associated with patients’ long-term use of OAC. Chapter 3 reviews the current literature around the safety and efficacy of direct oral anticoagulants (DOACs) compared to vitamin K antagonists (VKAs) in the early period after cardiac surgery. Subsequently, chapter 4 provides the rationale and design for the Direct Oral Anticoagulation versus Warfarin after Cardiac Surgery (DANCE) noninferiority, open-label vanguard trial. In chapter 5, I present the main conclusions of this thesis and areas for further research.