Pautas de anticoagulación de los pacientes con fibrilación auricular en las consultas de cardiología: estudio retrospectivo y multicéntrico

Abstract

Introduction and objectivesDirect acting oral anticoagulants (DOAC) are underused in patients with nonvalvular atrial fibrillation (NVAF). Our objective is to determine the proportion of patients with NVAF seen in cardiology consultations with an indication for DOAC (according to the Therapeutic Positioning Report) who continue to be treated with vitamin K antagonists (VKA) and to determine the reasons why this change has not materialized. MethodsObservational, retrospective, multicenter, national study, based on medical records review of patients with NVAF seen in cardiology clinics. Results256 cardiologists participated in the study. 1238 patients with NVAF were included (mean age: 74.6 years; 40.6% women), 1204 received oral anticoagulants (41.7% VKA and 55.6% DOAC); 86.7% had a high thromboembolic risk (CHA2DS2-VASc ≥ 2) and 28.7% had a high risk of bleeding (HAS-BLED ≥ 3). Of the patients treated with VKA, 43.5% and 38% had a time outside the therapeutic range evaluated by the Rosendaal method or by the direct method, respectively. 36.8% (190/516) of the patients with VKA had some indication for treatment with DOAC, mainly the inability to maintain the INR within range (147 patients). The main difficulty in not prescribing a DOAC was bureaucratic barriers (87 patients). ConclusionsA high proportion of patients with NVAF seen in cardiology and under treatment with VKA have some indication to receive DOAC, this being mainly the inability to maintain an INR in therapeutic range. Bureaucratic barriers are the main difficulty in prescribing DOAC.