Efficacy and safety of anticoagulant treatment for non-valvular atrial fibrillation in multimorbid patients

Abstract

Assessment of the safety and efficacy of anticoagulant treatment in patients with nonvalvular atrial fibrillation (AF) in a multimorbidity setting. The cross-sectional study included 104 patients diagnosed with nonvalvular AF and followed in the medical facilities of Yekaterinburg. The subjects were interviewed, anthropometric measurements were made, and the risk of thromboembolic complications was evaluated using the CHA2DS2-VASc score. The Charlson multimorbidity index was calculated, and patients were divided into two groups: Group 1 with a low level of multimorbidity (not more than 5 points) and Group 2 with a high level of multimorbidity (6 points or more). The data are presented as a median and interquartile range (25%; 75%). The study population included 40 males and 64 females. The median age was 71 (62.5; 80) years. The level of multimorbidity was estimated as 5 (3; 6) points. Group 1 included 64 patients, and Group 2 included 40 patients. Thirty-nine percent of the sample patients had a paroxysmal form of AF, 10% had a persistent form, and 51% had permanent AF. The group of patients with a high level of multimorbidity included more patients with permanent AF and fewer patients with paroxysmal AF as compared with a moderate level of multimorbidity (p<0.01). Anticoagulant treatment was indicated for 92 (88.5%) patients. It was administered to 70.7% of patients; 29.3% did not receive it. Among patients receiving anticoagulants, warfarin was administered to 18.5%, and new oral anticoagulants (NOACs) were administered to 81.5%. Complications were reported in 15.2% of anticoagulant treatment cases. Bleeding was reported in 21.7% of cases of warfarin administration and 12.5% of cases of NOAC treatment (p=0.32). The median number of risk factors for bleeding per patient was 5 (4; 5.5). The Charlson index and the total number of risk factors are significantly correlated (R=0.37, p<0.05). In real-world clinical practice in Ekaterinburg, Russia, 7 of 10 patients with AF for whom anticoagulant treatment was indicated actually received it; NOACs are prescribed four times more often than warfarin. With a higher level of multimorbidity, the risk of bleeding under the pressure of anticoagulant treatment increases; thus, NOACs should be preferred over warfarin for treatment of multimorbid patients.