(C-084) Oral Anticoagulant Use by Comorbidity in Long-term Care: A Population-based Cross-Sectional Study

Tuesday, August 26, 2025

12:00 PM - 1:30 PM ET

Co-Author(s)

SH

Stephanie L. Harrison, PhD

Registry of Senior Australians Research Centre, South Australian Health and Medical Research Institute and Flinders University, South Australia, Australia
Janet K. Sluggett, BPharm(Hons), GDip ClinEpi, PhD, FANZCAP, FSHP

Associate Professor in Pharmacy & Pharmacoepidemiology
University of South Australia, Australia
CL

Catherine Lang

Registry of Senior Australians Research Centre, South Australian Health and Medical Research Institute and Flinders University, Australia
TA

Tracy Air

Registry of Senior Australians Research Centre, South Australian Health and Medical Research Institute and Flinders University, Australia
CW

Craig Whitehead

College of Medicine an dPublic Health, Flinders University, South Australia, Australia
MI

Maria Inacio

Registry of Senior Australians, South Australian Health and Medical Research Institute, South Australia, Australia

Presenting Author(s)

GC

Gillian E. Caughey, PhD

Professor of Health Services and Pharmacoepidemiology
Registry of Senior Australians Research Centre, South Australian Health and Medical Research Institute and Flinders University
Adelaide, South Australia, Australia

Background: The introduction of direct oral anticoagulants (DOACs) has resulted in increased use of oral anticoagulants (OACs) for many population groups that were typically undertreated. Little is known regarding OAC use by older people living in long-term care where multiple high-risk comorbidities including dementia, and concerns of increased bleeding risk, potentially contribute to under-prescription of OACs.

Objectives: To examine national trends in use of OACs and other antithrombotic medicines by older people in long-term care by comorbid conditions.

Methods: A repeated population-based cross-sectional study was conducted using the Registry of Senior Australians Historical Cohort. All individuals aged ≥65 years residing in long-term care between Jan 2013-Dec 2019 were included. Hospitalisation data were used to determine atrial fibrillation (AF), venous thromboembolism (VTE), pulmonary embolism (PE), ischaemic stroke and gastrointestinal bleed. Dementia was ascertained from hospitalisation, medication and aged care assessment data. Yearly age and sex adjusted prevalence and 95% confidence intervals (CI) were estimated using Generalised Estimating Equation (GEE) Poisson models, with robust standard errors to account for non-independence of observations. Adjusted prevalence ratios (aPRs) to estimate linear trends were calculated using GEE Poisson models.

Results: In total 500883 individuals were included; 63.0% (n=315658) were female, median (IQR) age 86 (80-90), 12.0% (n=60018) had a hospitalisation for AF, 2.4% (n=11771) VTE, 1.0% (n=5038) PE, 3.6% (n=17818) ischaemic stroke, 2.9% (n=14628) GI bleed and 58.3% (n=292357) were living with dementia. Overall, the proportion of individuals receiving OACs increased from 12.2% (95%CI 12.1-12.4) in 2013 to 16.5% (16.4-16.7) in 2019 (aPR 1.05 (1.05-1.06). This was driven by increases in DOACs [2.2% (2.2-4.2) in 2013 to 12.5% (12.3-12.6) in 2019, aPR 1.25 (95%CI 1.25-1.26)]. Reductions in warfarin (aPR 0.89 95%CI 0.89-0.90), heparin (aPR 0.96 95%CI 0.96-0.97) and antiplatelets (aPR 0.83 95%CI 0.82-0.83) were observed. Increases in DOACs were observed for all conditions examined (e.g., GI bleed 2.0%, 95%CI 2.0-2.4 in 2013 to 12.2%, 95%CI 11.4-12.9 in 2019, aPR 1.24 95%CI 1.21-1.26). While use of DOACs increased for people living with dementia from 1.9% to 10.0% (aPR 1.25 95%CI 1.24-1.25), use remained consistently lower compared to those without dementia (2019 estimate 15.8%, 95%CI 15.6-16.0).

Conclusions: This population-based study showed increases in use of OACs in long-term care including in potentially high-risk groups such as those with prior GI bleed. Appropriate anticoagulation in residents with dementia likely remains suboptimal.