Impact of New Criteria for Anticoagulant Treatment in Atrial Fibrillation

Abstract

Introduction and objectives The guidelines for the management of atrial fibrillation (AF) incorporate new risk factors for thromboembolism, trying to de-emphasize the use of the ‘low’, ‘moderate’, and ‘high’ risk categories. The objective of this study was to determine the impact of the new scheme CHA2DS2-VASc and of the new recommendations for oral anticoagulation (OAC) in a contemporary sample of patients with AF seen by primary physicians and cardiologists. Methods Multicenter, observational, cross-sectional study on the epidemiology of hypertension and its control, designed by the arterial hypertension department. Each researcher enrolled the first 6 consenting patients who came for examination during a 5-day period. Results Of 25 137 individuals recruited, 1544 were diagnosed with AF. The vast majority of the sample had a CHADS 2 score ≥2 (77.3%). Individuals with a risk score lower than 2 were categorized according to the CHA 2DS 2-VASc score: 14.4% were aged 75 years or older (CHA 2DS 2-VASc = 2). Of those younger than 75, 42.3% had a CHA 2DS 2-VASc = 2; 23.7% CHA 2DS 2-VASc = 3, and 1.1% CHA 2DS 2-VASc = 4. This means that the 85.1% of the patients with a CHADS 2 score < 2 and no contraindications are indicated for OAC. Conclusions The new recommendations will result in a significant increase in patients with indications for OAC, at the expense of those previously characterized as low-to-moderate risk. Therefore, patients at risk of thromboembolic events must be identified, although an evaluation of bleeding risk should be part of the patient assessment before starting anticoagulation.