Preference for oral anticoagulation therapy for patients with atrial fibrillation in Europe in different clinical situations: results of the European Heart Rhythm Association Survey.
The purpose of this European Heart Rhythm Association Survey was to assess the clinical practice in relation to the use of oral anticoagulation therapy for patients with atrial fibrillation (AF) in Europe. Of special interest were patients undergoing percutaneous coronary intervention (PCI), cardioversion procedures, catheter ablation, surgery, and those suffering from anticoagulation-related bleeding. Of 38 responding centres, non-vitamin K antagonist oral anticoagulants (NOACs) were used for stroke prophylaxis and were preferred (33.3%) or considered equal (48.5%) to vitamin K antagonists (VKAs). Only 3% did not use NOACs at all. There were some practice differences regarding the use of NOACs in combination with dual antiplatelet therapy in AF patients undergoing PCI, and only 12% preferred using NOACs in this setting. Bare metal stents were preferred rather than drug-eluting stents in AF patients at high bleeding risk. There were clear practice differences between centres regarding the use of triple therapy. Most of the major bleeding events would be handled using symptomatic and supportive measures (e.g. mechanical compression, fluid replacement, blood transfusion, prothrombin complex concentrate, or recombinant Factor VIIa). More than 80% of the centres offer either VKA or NOAC for at least 3 weeks before and after cardioversion and 70% offer either VKA or NOAC before and after AF catheter ablation. Patients treated with an NOAC were routinely re-assed in most centres.
Department of Cardiology, Aalborg AF Study Group, Aalborg University Hospital, Søndre Skovvej 15, Aalborg DK-9000, Denmark tobl@rn.dk.
Torben Bjerregaard
TB
Larsen
Cardiology Clinic, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia.
Tatjana
T
Potpara
Second Department of Cardiology, University of Athens, ATTIKON University Hospital, Athens, Greece.
Nikolaos
N
Dagres
Department of Cardiothoracic Science, University Hospital S. Maria Della Misericordia, Udine, Italy.
Alessandro
A
Proclemer
Department of Cardiology, Institution of Medical Science, Uppsala University, Uppsala, Sweden.
Elena
E
Sciarrafia
Carina
C
Blomström-Lundqvist
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D017115:Catheter Ablation; D015897:Comorbidity; D004359:Drug Therapy, Combination; D004554:Electric Countershock; D005060:Europe / Q000453:epidemiology; D019983:Guideline Adherence / Q000639:trends; D019538:Health Care Surveys; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
Anticoagulation; Bleeding; CHA2DS2VASc; EHRA survey; EP Wire; Guidelines; HAS-BLED; New oral anticoagulants; Stroke; Warfarin