Sažetak sa skupa

https://doi.org/10.15836/ccar2019.239

Patterns of anticoagulation and clinical outcomes in atrial fibrillation: insights from a single institution registry

Ivana Jurin
Marko Lucijanić
Andjela Jurišić
Tomislava Bodrožić Džakić Poljak
Jasmina Ćatić
Boris Starčević
Irzal Hadžibegović orcid.org/0000-0002-3768-9134

Sažetak

Aim: To investigate clinical outcomes in patients with atrial fibrillation exposed to different types of
anticoagulant drugs within a single institution retrospective registry.
Patients and Methods: A cohort of 758 consecutive patients with non- valvular atrial fibrillation receiving
anticoagulation therapy after first referral to our institution in a period from 2012 to 2018. We
analyzed demographic and clinical data, first choice anticoagulation therapy and time of any of the
following clinical outcomes: death, thromboembolic event, and major bleeding and performed univariate
and multivariate analyses.
Results: There were 434 (57%) patients receiving warfarin, and 178 (23%) and 146 (20%) patients receiving
dabigatran and AntiXa, respectively. There was a statistically significant trend of increase in
frequency of DOAC use over time (P=0.002). Patients anticoagulated with warfarin were significantly
older, had lower eGFR and LVEF, had more frequent chronic heart failure, coronary artery disease, permanent
atrial fibrillation, higher CHA2DS2VASC and higher HAS-BLED scores than DOAC receiving
patients (P<0.05 for all comparisons). Only 11% of patients on warfarin had acceptable recorded time in
therapeutic range values. Univariately, there were significantly more events in patients treated with
warfarin than with DOACs (p<0,001 for all events). After adjusting for age, eGFR, and EFLV time to death
(HR=5.08, 95% CI (2.23-11.61), P<0.001) and time to thromboembolic event (HR=3.38, 95% CI (1.30-11.12),
P=0.045) were significantly shorter in warfarin then in DOAC treated patients, whereas time to major
bleeding (HR=1.01, 95% CI (0.84-2.55), P=0.110) did not differ significantly.
Conclusion: Patients with higher risk received warfarin more frequently, possibly due to reimbursement
issues. Patients receiving warfarin experience significantly higher adjusted risks of thrombosis
and death, probably reflecting differences in patients’ characteristics and predetermined risks for
stroke or other cardiovascular events at baseline. Although the use of DOACS increased over time,
changes in DOAC availability for all patients should be made to optimize patterns of anticoagulation
in atrial fibrillation.1

Ključne riječi

atrial fibrillation; stroke prevention; anticoagulation.

Hrčak ID:

226708

URI

https://hrcak.srce.hr/226708

Datum izdavanja:

15.10.2019.

Posjeta: 614 *