KEy wordsantithrombotic therapy, atrial fibrillation, non--vitamin K antagonist oral anticoagulants, vitamin K antagonists AbstrAct IntroductIon Data on antithrombotic treatment among patients with atrial fibrillation (AF) in Poland are limited.objEctIvEs We aimed to describe antithrombotic management within the Polish part of the EUROobservational Research Programme on Atrial Fibrillation General Long -Term Registry.
PAtIEnts And mEthodsWe analyzed data collected at baseline and at 1 -year follow -up from 701 Polish patients treated at 25 Polish centers between 2013 and 2016. rEsuLts Any antithrombotic therapy was administered to 94% of patients (vitamin K antagonists [VKAs], 53%; non -VKA oral anticoagulants [NOACs], 36%; antiplatelet therapy [APT], 4.8%). However, 78% of patients considered as "low -risk" (CHA 2 DS 2 -VASc = 0 in men or 1 in women) were prescribed oral anticoagulants and 12% were on APT. Independent predictors of NOAC and VKA use were first -detected AF and device therapy. Predictors of VKA use were lone AF, history of ischemic stroke, and pulmonary embolism or deep vein thrombosis; of NOAC use, permanent AF; of APT use, history of hemorrhagic events and first -detected or persistent AF; and of no antithrombotic treatment, young age. Incorrect NOAC prescription was more common in the reduced -dose group than in the full -dose group (30% vs 7%). During follow -up, the all -cause mortality rate was 5.2%, 0.8%, 15%, and 7% (P <0.0001) and the risk of thromboembolic events was 0.4%, 0.5%, 6.2%, and 0% (P = 0.04) in patients on VKA, NOAC, APT, and no treatment, respectively. concLusIons Patients with the lowest stroke risk are often overtreated. The choice of proper antithrombotic strategy does not depend solely on factors incorporated in the CHA 2 DS 2 -VASc score. Higher mortality is observed among APT -treated patients and those without antithrombotic treatment. 30 Gorin L, Fauchier L, Nonin E, et al. Antithrombotic treatment and the risk of death and stroke in patients with atrial fibrillation and a CHADS2 score = 1. Thromb Haemost. 2010; 103: 833-840. 31 Cheng CM, Lin CH, Chou P, et al. Antithrombotic treatment may reduce mortality among new -onset atrial fibrillation patients with gray -zone risk of stroke. Int Heart J. 2019; 60: 303-309. 32 Xu Y, Schulman S, Dowlatshahi D, et al. Direct oral anticoagulant-or warfarin -related major bleeding: characteristics, reversal strategies, and outcomes from a multicenter observational study. Chest. 2017; 152: 81-91.