Abstract
Abstract Background: Despite the efficacy of vitamin K antagonists against stroke in patients with atrial fibrillation (AF), the underuse of this therapy is well documented. Objectives: To evaluate trends and predictors of oral anticoagulants utilization in patients with AF. Methods: Observational, retrospective, serial cross-sectional study between 2011-2016. Comparisons between groups were performed using the Student t, Mann-Whitney and Chi-square tests. Logistic regression was used to identify independent predictors of anticoagulation. A p value < 0.05 was considered significant. Results: A total of 377 patients were analyzed. The mean age was 70 ± 15 years; 52% were male and 75% were anticoagulated (20% with VKA and 55% with DOAC). Over 5 years, the overall frequency of anticoagulation increased by 22.4%. The use of DOACs increased from 29% to 70%, whereas the use of VKA decreased from 36% to 17%. The use of antiplatelet agents alone also fell from 21% to 6%. The predictors of anticoagulation were previous episodes of AF (OR 3.1, p < 0.001), hypertension (OR 3.0, p < 0.001) and HASBLED score (OR 0.5, p < 0.001). The predictors of DOAC use were serum creatinine (OR 0.2, p = 0.002), left atrial size (OR 0.9, p = 0.003) and biological valve prosthesis (OR 0.1, p = 0.007). Of the 208 patients using DOACs, 63 (30%) received inadequate prescriptions: 5 with severe drug interactions and 58 with incorrect dosing. Conclusions: Between 2011 and 2016, DOACs were rapidly incorporated into clinical practice, replacing AVKs and antiplatelets, and contributing to greater use of anticoagulation in patients with AF.
Highlights
Atrial fibrillation (AF) affects about 1–2% of the world’s population and is associated with a five-fold increased risk of stroke
The group on anticoagulants was subsequently divided into patients using vitamin K antagonists (VKA) or direct-acting oral anticoagulants (DOACs) (Table 1)
The mean age of the patients was 70 ± 15 years, and 52% were male with mean body mass index (BMI) of 27 ± 6
Summary
Atrial fibrillation (AF) affects about 1–2% of the world’s population and is associated with a five-fold increased risk of stroke. The use of vitamin K antagonists (VKA) as anticoagulants reduces the risk of stroke or systemic embolism by 64% and all-cause death by 26%.1-7. Over the past 10 years, several randomized trials, involving more than 70,000 patients with AF, compared the use of AVK with direct-acting oral anticoagulants (DOACs). In these studies, DOACs were at least as effective as VKAs in preventing thromboembolic events and promoted a significant reduction in the frequency of intracranial hemorrhage.[11] In addition, DOACs. Despite the efficacy of vitamin K antagonists against stroke in patients with atrial fibrillation (AF), the underuse of this therapy is well documented. Conclusions: Between 2011 and 2016, DOACs were rapidly incorporated into clinical practice, replacing AVKs and antiplatelets, and contributing to greater use of anticoagulation in patients with AF. (Int J Cardiovasc Sci. 2020;33(1):68-78) Keywords: Atrial Fibrillation; Anticoagulants; Brain Ischemia; Vitamin K/antagonists & inhibitors; Thromboembolism/ prevention & control
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