Therapy in the Prevention of Thromboembolic Complications in Patients with Atrial Fibrillation: Prospects for Higher Appointment of New Oral Anticoagulants in Сlinical Рractice

Abstract

Objective: To analyze the assignability of anticoagulation in patients with atrial fibrillation (including new oral anticoagulants (NOAC)) and detection of paroxysmal supraventricular tachycardia (SVT), according to a cohort study conducted on the rules of the local registry. Methods: Patients with atrial fibrillation, selected from 526 patients treated in the department in 2013, accounted study group (n = 58). Analysis of prescribed therapy, the percentage of anticoagulant therapy (including the new oral anticoagulants), detection of SVT held on all enrolled patients. Results: use of anticoagulants in the study group was 46.5% (NOAC - 20.7%). The main reason fails to appoint anticoagulant therapy were follows: the inability of the patient to adhere or to monitor warfarin therapy and the presence of valvular AF, which does not allow to recommend NOAC (48.4%) and physician preference, based on the refusal or the patient's preference (41.9%). The presence of valvular AF significantly limited the possibility of appointing the NOAC. SVT has been registered by Holter ECG during hospitalization in 24 patients with AF. Moreover 12 patients without AF were previously identified SVT. Conclusions: The appointment of anticoagulants in patients with AF is insufficient. More active use of NOAC will allow to correct current situation. The correct interpretation of the concept of valvular AF can help it. Considering that under the mask of paroxysmal SVT described by Holter ECG may be hiding paroxysmal AF, open to debate is the question of the appointment of anticoagulant therapy in these patients. Answer this question will be able to conduct of specially-designed randomized clinical trials.