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Observational Study
. 2021 Aug 9;21(1):384.
doi: 10.1186/s12872-021-02019-0.

Demographic, clinical, and functional determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation

Jose María Mostaza  1 , Carmen Suarez  2 , Jose María Cepeda  3 , Luis Manzano  4 , Demetrio Sánchez  5 ; PERFILAR study investigators
Collaborators, Affiliations
Observational Study

Demographic, clinical, and functional determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation

Jose María Mostaza et al. BMC Cardiovasc Disord. .

Abstract

Background: This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting.

Methods: A multicenter, cross-sectional study was conducted in NVAF patients who attended internal medicine departments for either a routine visit (outpatients) or hospitalization (inpatients).

Results: A total of 961 patients were evaluated. Their antithrombotic management included: no treatment (4.7%), vitamin K antagonists (VKAs) (59.6%), direct oral anticoagulants (DOACs) (21.6%), antiplatelets (6.6%), and antiplatelets plus anticoagulants (7.5%). Permanent NVAF and congestive heart failure were associated with preferential use of oral anticoagulation over antiplatelets, while intermediate-to high-mortality risk according to the PROFUND index was associated with a higher likelihood of using antiplatelet therapy instead of oral anticoagulation. Longer disease duration and institutionalization were identified as determinants of VKA use over DOACs. Female gender, higher education, and having suffered a stroke determined a preferential use of DOACs.

Conclusions: This real-world study showed that most elderly NVAF patients received oral anticoagulation, mainly VKAs, while DOACs remained underused. Antiplatelets were still offered to a proportion of patients. Longer duration of NVAF and institutionalization were identified as determinants of VKA use over DOACs. A poor prognosis according to the PROFUND index was identified as a factor preventing the use of oral anticoagulation.

Keywords: Antithrombotic treatment; Direct-acting oral anticoagulants (DOACs); Nonvalvular atrial fibrillation (NVAF); Vitamin K antagonists (VKAs).

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Conflict of interest statement

C. Suarez has received speaker honoraria or advisory board fees from BMS/Pfizer, Bayer, and Daiichi Sankyo. J.M. Cepeda has received speaker honoraria and advisory board fees from BMS/Pfizer, Bayer, and Daiichi Sankyo. L. Manzano has received speaker honoraria or advisory board fees from BMS/Pfizer, Bayer, Boehringer Ingelheim and Daiichi Sankyo. D. Sánchez has received payments from collaborations with Bayer, BMS/Pfizer, Boehringer Ingelheim and Daiichi Sankyo. J.M. Mostaza declares that he does not have any conflict of interest.

Figures

Fig. 1
Fig. 1
Study patient flow chart
See this image and copyright information in PMC

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