Real-practice thromboprophylaxis in atrial fibrillation

Deambrosis, Paola; Bettiol, Alessandra; Bolcato, Jenny; Pirolo, Roberta; Franchin, Giulia; Themistoclakis, Sakis; Pellizzari, Michele; Chinellato, Alessandro; Giusti, Pietro

doi:10.1515/acph-2017-0016

Abstract

This retrospective observational study was based on databases of the Local Health Authority of Treviso, Italy. It evaluated the prevalence and the effectiveness of oral anticoagulation treatment (OAT) for the management of nonvalvular atrial fibrillation (NVAF) in everyday clinical practice. Out of 6,138 NVAF patients, only 3,024 received vitamin K antagonist (VKA). Potential barriers decreasing the probability of being treated with VKA were female sex, older age, antiplatelet treatment and history of bleeding. In addition, VKA-treatment was not in line with current ESC and AIAC guidelines, since the patients at high or low risk of stroke were under- or over-treated, resp. Among VKAtreated patients, 73 % of subjects were not at target with anticoagulation. OAT resulted to be effective in reducing stroke risk. However, stroke events were significantly influenced also by previous stroke or transient ischemic attack (hazard ratio, HR = 2.99, p < 0.001) and by previous bleeding events (HR = 1.60, p < 0.001).

References

1. M. D. Ezekowitz, Atrial fibrillation: the epidemic of the new millennium, Ann. Intern. Med. 131 (1999) 537-538; DOI: 10.7326/0003-4819-131-7-199910050-00011.10.7326/0003-4819-131-7-199910050-0001110507965
Search in Google Scholar Back to article
2. A. S. Go, E. M. Hylek, K. A. Phillips, Y. Chang, L. E. Henault, J. V. Selby and D. E. Singer, Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) study, JAMA 285 (2001) 2370-2375; DOI: 10.1001/jama.285.18.2370.10.1001/jama.285.18.237011343485
Search in Google Scholar Back to article
3. Y. Miyasaka, M. E. Barnes, B. J. Gersh, S. S. Cha, K. R. Bailey, W. P. Abhayaratna, J. B. Seward and T. S. M. Tsang, Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence, Circulation 114 (2006) 119-125; DOI: 10.1161/CIRCULATIONAHA.105.595140.10.1161/CIRCULATIONAHA.105.59514016818816
Search in Google Scholar Back to article
4. M. Zoni-Berisso, A. Filippi, M. Landolina, O. Brignoli, G. D’Ambrosio, G. Maglia, M. Grimaldi and G. Ermini, Frequency, patient characteristics, treatment strategies, and resource usage of atrial fibrillation (from the Italian Survey of Atrial Fibrillation Management [ISAF] study), Am. J. Cardiol. 111 (2013) 705-711; DOI: 10.1016/j.amjcard.2012.11.026.10.1016/j.amjcard.2012.11.02623273528
Search in Google Scholar Back to article
5. C. Bilato, M. C. Corti, G. Baggio, D. Rampazzo, A. Cutolo, S. Iliceto and G. Crepaldi, Prevalence, functional impact, and mortality of atrial fibrillation in an older Italian population (from the Pro.V.A. study), Am. J. Cardiol. 104 (2009) 1092-1097; DOI: 10.1016/j.amjcard.2009.05.058.10.1016/j.amjcard.2009.05.05819801031
Search in Google Scholar Back to article
6. P. A. Wolf, R. D. Abbott and W. B. Kannell, Atrial fibrillation: a major contributor to stroke in the elderly: the Framingham study, Arch. Intern. Med. 147 (1987) 1561-1564; DOI: 10.1001/archinte.1987.00370090041008.10.1001/archinte.1987.00370090041008
Search in Google Scholar Back to article
7. H. J. Lin, P. A. Wolf, M. Kelly-Hayes, A. S. Beiser, C. S. Kase, E. J. Benjamin and R. B. D’Agostino, Stroke severity in atrial fibrillation. The Framingham study, Stroke 27 (1996) 1760-1764; DOI: 10.1161/01.STR.27.10.1760.10.1161/01.STR.27.10.1760
Search in Google Scholar Back to article
8. D. A. Dulli, H. Stanko and R. L. Levine, Atrial fibrillation is associated with severe acute ischemic stroke, Neuroepidemiology 22 (2003) 118-123; DOI: 10.1159/000068743.10.1159/00006874312629277
Search in Google Scholar Back to article
9. M. Lamassa, A. Di Carlo, G. Pracucci, A. M. Basile, G. Trefoloni, P. Vanni, S. Spolveri, M. C. Baruffi, G. Landini, A. Ghetti, C. D. Wolfe and D. Inzitari, Characteristics, outcome, and care of stroke associated with atrial fibrillation in Europe: data from a multicenter multinational hospital-based registry (The European Community Stroke Project), Stroke 32 (2001) 392-398; 10.1161/01.STR.32.2.392.
Search in Google Scholar Back to article
10. A. J. Camm, G. Y. Lip, R. De Caterina, I. Savelieva, D. Atar, S. H. Hohnloser, G. Hindricks, P. Kirchhof and ESC Committee for Practice Guidelines (CPG), 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association, Eur. Heart J. 33 (2012) 2719-2747; DOI: 10.1093/eurheartj/ehs253.10.1093/eurheartj/ehs25322922413
Search in Google Scholar Back to article
11. A. Raviele, M. Disertori, P. Alboni, E. Betrtaglia, G. Botto, M. Brignole, R. Cappato, A. Capucci, M. Del Greco, R. De Ponti, M. Di Biase, G. Di Pasquale, M. Gulizia, F. Lombardi, S. Themistoclakis and M. Tritto, AIAC guidelines on the management and treatment of atrial fibrillation. Update 2013. Associazione Italiana di Aritmologia e Cardiostimolazione, Gior. Ital. Cardiol. (Rome) 14 (2013) 215-240; DOI: 10.1714/1234.13660.
Search in Google Scholar Back to article
12. D. E. Singer, G. W. Albers, J. E. Dalen, A. S. Go, J. L. Halperin and W. J. Manning, Antithrombotic therapy in atrial fibrillation: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy, Chest 126 (Suppl. 3) (2004) 429S-456S; DOI: 10.1378/chest.126.3_suppl.429S.10.1378/chest.126.3_suppl.429S15383480
Search in Google Scholar Back to article
13. I. M. Ogilvie, N. Newton, S. A. Welner, W. Cowell and G. Y. Lip, Underuse of oral anticoagulants in atrial fibrillation: a systematic review, Am. J. Med. 123 (2010) 638-645; DOI: 10.1016/j.amjmed.2009.11.025.10.1016/j.amjmed.2009.11.02520609686
Search in Google Scholar Back to article
14. S. J. Connolly, J. Pogue, J. Eikelboom, G. Flaker, P. Commerford, M. G. Franzosi, J. S. Healey and S. Yusuf, ACTIVE W Investigators, Benefit of oral anticoagulant over antiplatelet therapy in atrial fibrillation depends on the quality of international normalized ratio control achieved by centers and countries as measured by time in therapeutic range, Circulation 118 (2008) 2029-2037; DOI: 10.1161/CIRCULATIONAHA.107.750000.10.1161/CIRCULATIONAHA.107.75000018955670
Search in Google Scholar Back to article
15. P. L. Hess, M. J. Mirro, H. C. Diener, J. W. Eikelboom, S. M. Al-Khatib, E. M. Hylek, H. B. Bosworth, B. J. Gersh, D. E. Singer, G. Flaker, J. L. Mega, E. D. Peterson, J. S. Rumsfeld, B. A. Steinberg, A. K. Kakkar, R. M. Califf and C. B. Granger, Atrial Fibrillation Think-Tank Participants, Addressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: Proceedings, Washington, DC, December 3-4, (2012), Am. Heart J. 168 (2014) 239-247; DOI: 10.1016/j.ahj.2014.04.007.10.1016/j.ahj.2014.04.007426955525173533
Search in Google Scholar Back to article
16. M. Zalesak, K. Siu, K. Francis, C. Yu, H. Alvrtsyan, Y. Rao, D. Walker, S. Sander, G. Miyasato, D. Matchar and H. Sanchez, Higher persistence in newly diagnosed nonvalvular atrial fibrillation patients treated with dabigatran versus warfarin, Circ. Cardiovasc. Qual. Outcomes 6 (2013) 567-574; DOI: 10.1161/CIRCOUTCOMES.113.000192.10.1161/CIRCOUTCOMES.113.00019223922182
Search in Google Scholar Back to article
17. S. Capizzi, M. L. Specchia, A. M. Ferriero, C. Cadeddu, A. Mancuso, C. De Waure, G. La Torre and G. Ricciardi, La gestione della TAO con i nuovi farmaci anticoagulanti orali: una nuova frontiera, in Rivaroxaban per la prevenzione dell’ictus in pazienti con fibrillazione atriale: risultati di una valutazione di HTA, Quaderni Ital. J. Pub. Health (QIJPH) 2 (2013) 80-104.
Search in Google Scholar Back to article
18. C. T. January, L. S. Wann, J. S. Alpert, H. Calkins, J. E. Cigarroa, J. C. Cleveland, J. B. Conti, P. T. Ellinor, M. D. Ezekowitz, M. E. Field, K. T. Murray, R. L. Sacco, W. G. Stevenson, P. J. Tchou, C. M. Tracy and C. W. Yancy, 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: Executive summary. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society, Circulation 130 (2014) 2071-2104; DOI: 10.1161/CIR.0000000000000040.10.1161/CIR.000000000000004024682348
Search in Google Scholar Back to article
19. B. F. Gage, A. D. Waterman, W. Shannon, M. Boechler, M. W. Rich and M. J. Radford, Validation of clinical classification schemes for predicting stroke - Results from the National Registry of Atrial Fibrillation, JAMA 285 (2001) 2864-2870; DOI: 10.1001/jama.285.22.2864.10.1001/jama.285.22.286411401607
Search in Google Scholar Back to article
20. M. Hughes and G. Y. Lip, Guideline Development Group, National Clinical Guideline for Management of Atrial Fibrillation in Primary and Secondary Care, National Institute for Health and Clinical Excellence, Stroke and thromboembolism in atrial fibrillation: a systematic review of stroke risk factors, risk stratification schema and cost effectiveness data, Thromb. Haemost. 99 (2008) 295-304; DOI: 10.1160/TH07-08-0508.10.1160/TH07-08-050818278178
Search in Google Scholar Back to article
21. J. B. Olesen, C. Torp-Pedersen, M. L. Hansen and G. Y. Lip, The value of the CHA2DS2-VASC score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS2 score 0-1: a nationwide cohort study, Thromb. Haemost. 107 (2012) 1172-1179; DOI: 10.1160/TH12-03-0175.10.1160/TH12-03-017522473219
Search in Google Scholar Back to article
22. F. R. Rosendaal, S. C. Cannegieter, F. J. van der Meer and E. Briët, A method to determine the optimal intensity of oral anticoagulant therapy, Thromb. Haemost. 69 (1993) 236-239.10.1055/s-0038-1651587
Search in Google Scholar Back to article
23. S. Barra and S. Fynn, Untreated atrial fibrillation in the United Kingdom: Understanding the barriers and treatment options, J. Saudi Heart Assoc. 27 (2015) 31-43; DOI: 10.1016/j.jsha.2014.08.002.10.1016/j.jsha.2014.08.002427431025544820
Search in Google Scholar Back to article
24. E. C. O’Brien, D. N. Simon, L. A. Allen, D. E. Singer, G. C. Fonarow, P. R. Kowey, L. E. Thomas, M. D. Ezekowitz, K. W. Mahaffey, P. Chang, J. P. Piccini and E. D. Peterson, Reasons for warfarin discontinuation in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), Am. Heart J. 168 (2014) 487-494; DOI: 10.1016/j.ahj.2014.07.002.10.1016/j.ahj.2014.07.00225262258
Search in Google Scholar Back to article
25. P. J. Zimetbau, A. Thosani, H. T. Yu, Y. Xiong, J. Lin, P. Kothawala and M. Emons, Are atrial fibrillation patients receiving warfarin in accordance with stroke risk?, Am. J. Med. 123 (2010) 446-453; DOI: 10.1016/j.amjmed.2009.11.015.10.1016/j.amjmed.2009.11.01520399322
Search in Google Scholar Back to article
26. N. Mochalina, A. Jöud, M. Carlsson, M. E. Sandberg, A. Själander, T. Juhlin and P. J. Svensson, Antithrombotic therapy in patients with non-valvular atrial fibrillation in Southern Sweden: A population-based cohort study, Thromb. Res. 140 (2016) 94-99; DOI: 10.1016/j.thromres.2016.02.023.10.1016/j.thromres.2016.02.02326938155
Search in Google Scholar Back to article
27. C. Sarawate, M. V. Sikirica, V. J. Willey, M. F. Bullano and O. Hauch. Monitoring anticoagulation in atrial fibrillation, J. Thromb. Thrombolysis 21 (2006) 191-198; DOI: 10.1007/s11239-006-4968-z.10.1007/s11239-006-4968-z16622617
Search in Google Scholar Back to article
28. C. van Walraven, C. A. Jennings, N. Oake, D. Fergusson and A. J. Foster, Effect of study setting on anticoagulation control: a systematic review and metaregression, Chest 129 (2006) 1155-1166; DOI: 10.1378/chest.129.5.1155.10.1378/chest.129.5.115516685005
Search in Google Scholar Back to article

Real-practice thromboprophylaxis in atrial fibrillation

Abstract

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