title: Vitamin K and non-vitamin K antagonist oral anticoagulants for non-valvular atrial fibrillation in real-life.
abstract: BACKGROUND
  Current guidelines recommend vitamin K antagonists (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in patients with non-valvular atrial fibrillation (AF).
  
  
  METHODS
  We compared the clinical features of consecutive in- and out-patients with non-valvular AF newly-treated with NOACs or on treatment with VKAs.
  
  
  RESULTS
  Overall, 1314 patients newly-treated with NOACs and 1024 on treatment with VKAs were included in the study. The mean CHA2DS2-VASc score was 4.3±1.5 and 4.0±1.5 and the mean HAS-BLED score was 2.8±1.2 and 2.2±1.1 in the two groups, respectively (both p<0.001). Hypertension, previous stroke, female gender, vascular diseases and previous bleeding were more prevalent in NOACs patients. Renal failure, age ≥75years and congestive heart failure were more prevalent in VKAs patients. Among NOACs patients, 438 were given dabigatran, 463 rivaroxaban and 413 apixaban (33%, 35% and 31%, respectively). The mean CHA2DS2-VASc and HAS-BLED scores were higher in rivaroxaban or apixaban patients compared with dabigatran (both p<0.001) and VKAs patients (both p<0.001). A lower mean age was observed in patients newly-treated with dabigatran. Patients newly-treated with reduced doses of NOACs (599 patients, 45.5%) had a higher CHA2DS2-VASc (4.8±1.4 vs. 3.9±1.5 vs. 4.0±1.5) and HAS-BLED (2.9±1.1 vs. 2.8±1.2 vs. 2.2±1.1) scores compared with those treated with regular doses of NOACs or VKAs.
  
  
  CONCLUSIONS
  Patients given rivaroxaban and apixaban in clinical practice have a higher thrombotic and hemorrhagic risk in comparison with patients given dabigatran or VKAs. A considerable proportion of patients receive reduced doses of NOACs.
authors.affiliation: Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Italy. Electronic address: michelagiustozzi@hotmail.it.
authors.forename: Michela
authors.initials: M
authors.lastname: Giustozzi
authors.affiliation: Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Vedovati
authors.affiliation: Department of Medicine, Hospital of Assisi, Assisi, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Verdecchia
authors.affiliation: Emergency Medicine, S. Maria Delle Croci Hospital, Ravenna, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Pierpaoli
authors.affiliation: Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Melina
authors.initials: M
authors.lastname: Verso
authors.affiliation: Division of Cardiology, S. Matteo degli Infermi Hospital, Spoleto, Italy.
authors.forename: Serenella
authors.initials: S
authors.lastname: Conti
authors.affiliation: Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Cianella
authors.affiliation: Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Marchesini
authors.affiliation: Unit of Angiology, S. Giovanni Battista Hospital, Foligno, Italy.
authors.forename: Esmeralda
authors.initials: E
authors.lastname: Filippucci
authors.affiliation: Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.affiliation: Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Becattini
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D000069604:Dabigatran / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011720:Pyrazoles / Q000009:adverse effects / Q000627:therapeutic use; D011728:Pyridones / Q000009:adverse effects / Q000627:therapeutic use; D000069552:Rivaroxaban / Q000009:adverse effects / Q000627:therapeutic use; D012720:Severity of Illness Index; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D011720:Pyrazoles; D011728:Pyridones; D014812:Vitamin K; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Non-valvular atrial fibrillation; Non-vitamin K antagonist oral anticoagulants; Vitamin-K antagonists