Evaluation of the recommended prevention of thrombosis in hospitalised patients with atrial fibrillation and high thromboembolism risk

Abstract

Background: According to the applicable guidelines for stroke prevention, patients with a high risk of thromboembolic com-plications should receive oral anticoagulants.

Aim: The objective of the present study is to evaluate the prevention of thrombosis in patients with diagnosed atrial fibrillation (AF) on discharge and a high risk of stroke.

Methods: The present study is a retrospective single-centre registry. The analysis was carried out on the basis of the data on 4099 patients with non-valvular AF, who were discharged from the cardiology department in the years 2004-2012. 276 (67.3%) of those patients were reported to have a high thromboembolism risk.

Results: Oral anticoagulants in monotherapy or in combination were administered to 65% of patients with AF and high risk of stroke. Oral anticoagulants were recommended for 69.7% of patients with a low risk of bleeding and 59.3% of patients with a high risk of bleeding. The number of patients treated with oral anticoagulants within nine years of analysis was increasing: 61.7% in the years 2004-2006, 63.3% in the years 2007-2010, and 71.5% in the years 2011-2012. Factors that affected a decision to not introduce oral anticoagulants in patients with AF and high risk of stroke were hospitalisation in the years 2004-2006 (hazard ratio [HR] 0.72), high risk of bleeding (HR 0.70), vascular disease (HR 0.68), age ≥ 80 years (HR 0.52), history of bleeding (HR 0.55), and paroxysmal AF (HR 0.51).

Conclusions: Oral anticoagulants were indicated on discharge for 2/3 of patients with AF and high risk of stroke, and more often in patients with low risk of bleeding events. An increase in the number of indications for oral anticoagulation has been observed in the past nine years. The factors which led to no use of oral anticoagulation among AF patients with high stroke risk were: hospitalisation in the years 2004-2006, high risk of bleeding, vascular disease, age ≥ 80 years, paroxysmal AF, and previous bleeding.

Keywords: atrial fibrillation; high risk of stroke; oral anticoagulation; prophylaxis; stroke.