[Choice of antithrombotic therapy in patients with Non Valvular Atrial Fibrillation in real life].
BACKGROUND
Non-valvular atrial fibrillation (NVAF) is the most common cardiac arrhythmia and it is associated with a 5-fold increase in risk of ischemic stroke. Although clinical guidelines recommend antithrombotic therapy for stroke prevention in patients at moderate or high risk for stroke, little is known on the extent to which the increase of the risks influence the choice of the therapy.


OBJECTIVE
The aim of the study was to assess the level of adherence to the guidelines for the prevention of thromboembolic risk in patients with NVAF.


METHODS
A population-based cohort study was conducted using administrative data from a local health authority in the Campania Region (~1,000,000 inhabitants). NVAF was defined as one or more claims for atrial fibrillation between July, 2013 and June, 2014 where none of the claims were associated with cardioversion or cardiac ablation during the identification period and there was no evidence of valve-related diagnoses or procedures. The cohort was classified according to the first drug dispensing during 6 months from the discharge date for atrial fibrillation. Patients were categorized in low ischemic stroke risk (LR, score = 0), moderate-risk (MR, score = 1), high-risk (HR, score≥2) according to the CHA2DS2-VASc score. Multivariable logistic regression was used to evaluate the associations between ischemic stroke risk with the choice of non-vitamin K antagonist oral anticoagulants (NOACs) versus vitamin K antagonists (VKAs) therapy.


RESULTS
A total of 1963 patients were identified: 4.9% LR, 7.6% MR and 87.5% HR patients. Overall, 36.4% of patients were not treated (LR: 56.7%, MR: 55.0%, HR: 33.7%patients). The Vitamin K antagonists were prescribed to 17% of the patients (LR: 10.3%, MR: 12,1%, HR: 17,8%), NOAC to 12,7% (LR: 10,3%, MR: 8,1%, HR: 13,2%), low-dose aspirin to 17.5% (LR: 13,4%, MR: 15,4%, HR: 17,9%), other antiplatelet to 12,3% (LR: 7,2%, MR: 6,0%, HR: 13,2%). The ischemic stroke was not significantly associated with the choice of anticoagulant drug.


CONCLUSIONS
High proportion of NVAF patients with CHA2DS2-VASc score of 2 or greater not received oral anticoagulant as recommended. In contrast with recent guidelines, aspirin was commonly prescribed even in HR patients. The stroke risk stratification did not influence the choice of anticoagulant drug.
LinkHealth s.r.l., Health Economics, Outcomes & Epidemiology, Napoli - Centre for Pharmacoepidemiology, Karolinska Institutet, Svezia.
Anna
A
Citarella
Nucleo Tecnico Struttura Commissariale di Governo della Regione Campania, Napoli.
Antonella
A
Guida
UOC di Cardiologia/UTIC PO San Giovanni Bosco, Azienda Sanitaria Locale Napoli 1 Centro, Napoli.
Paolo
P
Capogrosso
Azienda Sanitaria Locale Napoli 1 Centro, Napoli.
Sara
S
Carotenuto
Azienda Sanitaria Locale Napoli 1 Centro, Napoli.
Simona
S
Creazzola
Azienda Sanitaria Locale Napoli 1 Centro, Napoli.
Claudia
C
De Marino
Azienda Sanitaria Locale Napoli 1 Centro, Napoli.
Pasquale
P
Izzo
Azienda Sanitaria Locale Napoli 1 Centro, Napoli.
Gaetana
G
La Bella
Azienda Sanitaria Locale Napoli 1 Centro, Napoli.
Raffaele
R
Piscitelli
Azienda Sanitaria Locale Napoli 1 Centro, Napoli.
Francesca
F
Romagnuolo
Azienda Sanitaria Locale Napoli 1 Centro, Napoli.
Ernesto
E
Esposito
UOC di Cardiologia/UTIC PO San Giovanni Bosco, Azienda Sanitaria Locale Napoli 1 Centro, Napoli.
Gennaro
G
Ratti
LinkHealth s.r.l., Health Economics, Outcomes & Epidemiology, Napoli.
Simona
S
Cammarota
D000925:Anticoagulants; D001281:Atrial Fibrillation; D002545:Brain Ischemia; D015331:Cohort Studies; D005343:Fibrinolytic Agents; D006801:Humans; D020521:Stroke
D000925:Anticoagulants; D005343:Fibrinolytic Agents