Do CHA<sub>2</sub>DS<sub>2</sub>VASc and HAS‐BLED scores influence ‘real‐world’ anticoagulation management in atrial fibrillation? 1556 patient registry from the reference cardiology centre

Łopatowska, Paulina; Tomaszuk‐Kazberuk, Anna; Młodawska, Elżbieta; Bachórzewska−Gajewska, Hanna; Małyszko, Jolanta; Dobrzycki, Sławomir; Musiał, Włodzimierz J.

doi:10.1002/pds.3878

Cited by 7 publications

(8 citation statements)

References 16 publications

(38 reference statements)

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“…The ESC guidelines for AF treatment encourage OAC treatment in high‐risk AF patients, and the introduction of NOACs that are safer and more comfortable for patients probably contributed to this increase in OAC use. In fact, multiple other studies mostly from Europe and the United States have attested to the rapid and massive adoption of all NOAC drugs in recent years 12,18,19,25‐34 . It is, thus, important to add data from different world regions to this literature.…”

Section: Discussionmentioning

confidence: 99%

Use of oral anticoagulation therapy in the first 3 months after the diagnosis of atrial fibrillation in Israel: A population‐based study

Kezerle

Tsadok

Senderey

et al. 2020

Cardiovasc electrophysiol

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Introduction: Oral anticoagulation (OAC) therapy reduces the risk of ischemic stroke in patients with atrial fibrillation (AF) while increasing the risk of bleeding.Recently, non-vitamin K antagonist oral anticoagulants (NOACs) have become available with lower rates of intracranial bleeding, and some of them have presented a reduced risk of major bleeding. The purpose of this study is to evaluate the change in purchasing patterns of OACs (both warfarin and NOACs) over time in patients with AF according to stroke and bleeding risk, in the first 3 months after diagnosis. Methods and Results:We conducted a historical cohort study using the Clalit Health Services electronic medical records database. The study population included all members aged ≥21 years, with a new diagnosis of nonvalvular AF between 2008 and 2015. A total of 58 385 cases were identified. The mean age was 73.1 (±14.1) years, and 52.3% of the patients were women. The median CHA 2 DS 2 -VASc score was 4 (interquartile range, 3-5). OACs were purchased by 19 705 patients (33.8%) within the first 3 months of first diagnosis of AF, with patients at higher embolic risk as stratified by the CHA 2 DS 2 -VASc score and having higher purchasing rates (37.1%). Between 2008 and 2010, 29% of patients purchased a vitamin K antagonist, the only available OAC at the time. OAC purchasing increased to 41.4% between 2014 and 2015, with half of the patients purchasing an NOAC. Conclusion:In this real-world, population-based cohort study of patients with newly diagnosed AF, we found a lower than expected rate of OAC prescription within 3 months of diagnosis but an encouraging increase in OAC purchasing over time. The use of NOACs has risen exponentially within just a few years, accounting for a greater pool of patients with being prescribed an OAC.

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Section: Discussionmentioning

confidence: 99%

Use of oral anticoagulation therapy in the first 3 months after the diagnosis of atrial fibrillation in Israel: A population‐based study

Kezerle

Tsadok

Senderey

et al. 2020

Cardiovasc electrophysiol

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“…Proposals for decision-making in NOACs use for these frail/high bleeding risk patients were recently suggested [ 58 - 60 ]. However, in the real world, NOACs were underutilized in these patients (e.g., elderly) [ 61 , 62 ]. Our results of Korean patients with AF and stroke showed that there was a negative correlation between CrCl and ATRIA score (a scheme for bleeding-risks), and patients who had features favoring NOAC use (i.e., a high ATRIA score) were more likely to have contraindications for NOACs use (i.e., a low CrCl) [ 5 ].…”

Section: Results Of Low Doses Of Warfarin and Non-vitamin K Oral Antimentioning

confidence: 99%

Asian Patients with Stroke plus Atrial Fibrillation and the Dose of Non-Vitamin K Oral Anticoagulants

2016

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After recent randomized control trials (RCTs), non-vitamin K oral anticoagulants (NAOAs) are now widely being used in patients with atrial fibrillation (AF) worldwide. However, current guidelines for the use of NOACs in patients with AF are derived mostly using a Caucasian population and non-stroke patients. Relatively few Asian patients with AF and stroke are included in the recent RCTs. As a result, the optimal use of NOACs in this particular group of patients is remains to be settled. The optimal dose of NOACs and response to current dose of NOACs of Asian patients with AF and stroke may differ from those of westerners and patients without stroke. We reviewed available research on NOACs by searching PubMed and ClinicalTrials.gov published in English up to December 2015. In this review, the characteristics of Asian AF patients with prior stroke/transient ischemic attack, which might influence the efficacy and safety profiles of NOACs, are discussed. In addition, we summarize the risk factors for bleeding complications on NOACs, which are related or unrelated with the blood level of NOACs. Lastly, we provide recent data of reduced dose of NOACs from RCTs or large cohorts. The results reviewed herein call for clinical trials to test whether a reduced dose of NOACs is beneficial in Asian patients with AF and stroke. In the meantime, further researches are needed to establish the safety and efficacy of dose-adjusted NOACs considering both blood levels of NOACs and fragility of patients in Asian patients with AF and stroke.

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“…In the present study the majority of patients were over 75 years and mean CHA 2 DS 2 VASc of patients treated with OAC amounted to 6.5 points, thus this study group was at the highest risk of thromboembolic events. Lopatowska et al [16] analyzed antithrombotic management in AF implemented into practice in a group of 1556 patients. The study showed that the use of OAC increased with increasing CHA 2 DS 2 VASc score but was less frequent in score ≥ 4 irrespectively of whether it was primary or secondary prevention.…”

Section: Discussionmentioning

confidence: 99%

Non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation in secondary stroke and systemic embolism prevention

et al. 2021

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Background: Oral anticoagulants (OAC) are recommended in all patients with atrial fibrillation (AF) after thromboembolic events without contraindications. It is hypothesized herein, that the majority of patients with AF after thromboembolic events receive OAC and the presence of specific factors, predisposes the use of non-vitamin K antagonist oral anticoagulants (NOACs). Methods: This is a retrospective study, encompassing patients with AF hospitalized in a reference cardiology center over the years 2014-2017. Thromboembolic events were defined as: ischemic stroke, transient ischemic attack and systemic embolism. Inclusion criteria were the following: diagnosis of non-valvular AF at discharge from hospital, hospitalization not resulting in death. Results: Among 2834 hospitalized patients with AF, a history of thromboembolic events was identified in 347 (12.2%) patients. In the group studied, of 347 patients with AF after a thromboembolic event, 322 (92.8%) received OAC, including 133 patients on vitamin K antagonist (41.3% of patients on OAC) and 189 patients on NOACs (58.7% of patients on OAC). Among patients treated with NOACs the majority were on dabigatran (116 patients, 61.4%), followed by rivaroxaban (54 patients, 28.6%), and apixaban (19 patients, 10%). Multivariate logistic regression analysis demonstrated that the presence of arterial hypertension reduced the chance for NOACs use (odds ratio [OR] 0.4, 95% confidence interval [CI] 0.2-0.9, p = 0.04) and left atrial size ≤ 40 mm was a factor increasing the chance for the use of NOACs (OR 2.5, 95% CI 1.1-5.8, p = 0.03). Conclusions: Nearly all hospitalized patients with AF received OAC in the secondary prevention of thromboembolic complications. NOACs were used for secondary prevention of stroke among patients with AF in patients with fewer comorbidities.

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Do CHA₂DS₂VASc and HAS‐BLED scores influence ‘real‐world’ anticoagulation management in atrial fibrillation? 1556 patient registry from the reference cardiology centre

Abstract: Antithrombotic management in AF is well implemented in Polish conditions, but we show the lack of pattern concerning who is being treated with OAC and ASA when it comes to the risk of stroke and bleeding.

Cited by 7 publications

References 16 publications

Use of oral anticoagulation therapy in the first 3 months after the diagnosis of atrial fibrillation in Israel: A population‐based study

Use of oral anticoagulation therapy in the first 3 months after the diagnosis of atrial fibrillation in Israel: A population‐based study

Asian Patients with Stroke plus Atrial Fibrillation and the Dose of Non-Vitamin K Oral Anticoagulants

Non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation in secondary stroke and systemic embolism prevention

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Do CHA2DS2VASc and HAS‐BLED scores influence ‘real‐world’ anticoagulation management in atrial fibrillation? 1556 patient registry from the reference cardiology centre

Abstract: Antithrombotic management in AF is well implemented in Polish conditions, but we show the lack of pattern concerning who is being treated with OAC and ASA when it comes to the risk of stroke and bleeding.

Cited by 7 publications

References 16 publications

Use of oral anticoagulation therapy in the first 3 months after the diagnosis of atrial fibrillation in Israel: A population‐based study

Use of oral anticoagulation therapy in the first 3 months after the diagnosis of atrial fibrillation in Israel: A population‐based study

Asian Patients with Stroke plus Atrial Fibrillation and the Dose of Non-Vitamin K Oral Anticoagulants

Non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation in secondary stroke and systemic embolism prevention

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Do CHA₂DS₂VASc and HAS‐BLED scores influence ‘real‐world’ anticoagulation management in atrial fibrillation? 1556 patient registry from the reference cardiology centre