The criteria of the Italian Federation of Thrombosis Centres on DOACs: a "real world" application in nonvalvular atrial fibrillation patients already on vitamin K antagonist.

Abstract

The aim of this study was to evaluate the number of patients with nonvalvular atrial fibrillation (NVAF), anticoagulated with vitamin K antagonists (VKA), and monitored in our Thrombosis Centre, who could replace VKA with direct oral anticoagulants (DOACs) based on the Italian Federation of Thrombosis Centres (FCSA) consensus criteria. A total of 525 NVAF patients treated with VKA were studied. Therapeutic range (TTR) assessment and a capillary test for serum creatinine measure were carried out. The patients' preference was evaluated through the administration of a dedicated questionnaire. A history of intracranial bleeding was also taken into account. DOACs would cover 29 % of the patients considering a TTR <70 %; the percentage falls to 10 % if a TTR <55 % is considered. Only 20 % of the patients would move from VKA to DOACs because of the lack of an antidote and laboratory checks during DOACs therapy. Thirty-three percent of patients were worried that they would forget to take the tablets twice a day. About 2 % of patients could not use DOACs since their glomerular filtration rate was less than 30 ml/min, while in 23.6 %, a reduction in the daily dose of DOACs would have been required due to renal failure. TTR assessment, renal function and a previous history of intracranial bleeding would reduce the percentage of patients who could switch from VKA to DOACs, but it is the patients' preference that strongly influences the percentage of those who would benefit from DOACs treatment. However, if laboratory controls were available, it would rise considerably.