Abstract
The management of patients with atrial fibrillation (AF) has rapidly changed with increasing use of non-vitamin K antagonist oral anticoagulants (NOACs) and changes in the use of rhythm control therapy. The prevention of thromboembolic events European Registry in Atrial Fibrillation Prolongation Registry (PREFER Prolongation) enrolled consecutive patients with AF on NOACs between 2014 and 2016 in a multicentre, prospective, observational study with one-year follow-up, focusing on the time of introduction of NOACs. Overall, 3783 patients were enrolled, with follow-up information available in 3223 (85%). Mean age was 72.2 ± 9.4 years, 40% were women, mean CHA2DS2VASc score was 3.4 ± 1.6, and 2587 (88.6%) had a CHA2DS2VASc score ≥ 2. Rivaroxaban was used in half of patients, and dabigatran and apixaban were used in about a quarter of patients each; edoxaban was not available for use in Europe at the time. Major cardiovascular event rate was low: serious events occurred in 74 patients (84 events, 2%), including 24 strokes (1%), 62 major bleeds (2%), of which 30 were life-threatening (1%) and 3 intracranial (0.1%), and 28 acute coronary syndromes (1%). Mortality was 2%. Antiarrhythmic drugs were used in about 50% of patients, catheter ablation in 5%. Adverse events were low in this contemporary European cohort of unselected AF patients treated with NOACs already at the time of their first introduction, despite high thromboembolic risk.
Highlights
The non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used as an alternative to vitamin K antagonists (VKAs) to prevent strokes in patients with atrial fibrillation (AF) [1,2,3,4]
Patients were included if they were at least 18 years of age, provided written informed consent for participation in the Registry, had a documented diagnosis of AF by ECG within the prior 12 months, and were treated with an oral anticoagulant. 10% of patients continued from PREFER in AF, of these around half were treated with VKAs and the remaining treated with NOACs
3783 patients were enrolled into the PREFER in AF Prolongation registry
Summary
The non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used as an alternative to vitamin K antagonists (VKAs) to prevent strokes in patients with atrial fibrillation (AF) [1,2,3,4]. They include the direct thrombin inhibitor dabigatran, and the direct factor Xa inhibitors rivaroxaban, apixaban and edoxaban. Extended author information available on the last page of the article phase III randomized clinical trials [5,6,7,8], NOACs showed a consistently favourable benefit-risk profile across a wide range of patients, with lower mortality and a lower rate of intracranial haemorrhage than patients randomized to VKA [9, 10].
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