Abstract
BackgroundThis study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting.MethodsA multicenter, cross-sectional study was conducted in NVAF patients who attended internal medicine departments for either a routine visit (outpatients) or hospitalization (inpatients).ResultsA total of 961 patients were evaluated. Their antithrombotic management included: no treatment (4.7%), vitamin K antagonists (VKAs) (59.6%), direct oral anticoagulants (DOACs) (21.6%), antiplatelets (6.6%), and antiplatelets plus anticoagulants (7.5%). Permanent NVAF and congestive heart failure were associated with preferential use of oral anticoagulation over antiplatelets, while intermediate-to high-mortality risk according to the PROFUND index was associated with a higher likelihood of using antiplatelet therapy instead of oral anticoagulation. Longer disease duration and institutionalization were identified as determinants of VKA use over DOACs. Female gender, higher education, and having suffered a stroke determined a preferential use of DOACs.ConclusionsThis real-world study showed that most elderly NVAF patients received oral anticoagulation, mainly VKAs, while DOACs remained underused. Antiplatelets were still offered to a proportion of patients. Longer duration of NVAF and institutionalization were identified as determinants of VKA use over DOACs. A poor prognosis according to the PROFUND index was identified as a factor preventing the use of oral anticoagulation.
Highlights
This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting
The majority of patients were treated with vitamin K antagonists (VKA), and Direct oral anticoagulants (DOAC) were received by less than onequarter of patients
Antiplatelet therapy alone was used in less than 7% of patients, and Oral anticoagulation (OAC) plus antiplatelet therapy was received by nearly 8% of patients (Fig. 1)
Summary
This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting. Direct-acting oral anticoagulants (DOACs) targeting thrombin or factor Xa emerged as a welcome addition for stroke prevention in AF These agents have predictable pharmacodynamic effects, allowing fixed dosing without the need for anticoagulation monitoring [10]. DOACs, such as rivaroxaban, dabigatran, apixaban and edoxaban, have demonstrated to be noninferior to warfarin in stroke prevention without an increased risk of major bleeding [11,12,13,14,15]. Based on their favorable efficacy, safety profile and convenience of use, DOACs are recommended over VKAs for stroke prevention in most patients with NVAF [16]
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