Objective: To provide a view on anticoagulant thera-py in an unselected, real-world, population of patients with NVAF, treated in a community setting.
Methods: Retrospective, observational case-series study of NVAF patients using antivitamin K antago-nists (AVK) (acenocumarol) or NOAC (apixaban, ri-varoxaban or dabigatran) for stroke prevention, as re-corded in our specialized-care center. The study inclu-des consecutive patients that presented between Jan 1st and Dec 31st 2018, who were assessed for stroke risk using CHA2DS2-VASc score. We noted the prevalence of treatment with AVK and NOAC administration at the admission in the hospital and discharge from the hospital, according to CHA2DS2-VASc score, rural versus urban area, INR, comorbidities.
Results: 186 patients with NVAF (mean age 72.2 ± 9.7 years, 53.8% women, 71% from urban areas) were evaluated in the hospital. 146 patients (78.5%) had au CHA2DS2-VASc high score (≥1 for men, ≥2 for wo-men) and high embolism risk. 40 patients (27.4%) had low embolic risk according to CHA 2 DS 2-VASc sco-re. Before the admission 36 patients (19.4%) received NOAC, 63 (33.9%) received AVK and 85 (45.7%) did not receive anticoagulation despite high CHA2DS2-VASc score, most of them from the rural area. 20 pa-tients with low embolism risk (50% ) received AVK or NOAC. 24 patients (38.1%) on AVK had therapeutic INR (2-3). At the discharge, 163 patients (87.6%) recei-ved anticoagulation, 58.9% of them NOAC. 16 patients (10,9%) with high embolism risk did not receive an-ticoagulation because of comorbidities (ongoing neo-plasia, hepatic chirrhosis). 16 patients (9.8% of them receiving anticoagulation) had minor bleeding to AVK (4,6%) and NOAC (10,9%). 33 patients (17.7%) with low embolic risk received anticoagulation.
Conclusions: In the real world nearly one in two pa-tients with NVAF remains untreated and two thirds of those receiving AVK are not therapeutically controlled in the community especially in the rural area. Upon reevaluation in a cardiac ward, 90% of moderate and high-risk patients received oral anticoagulant medi-cation, without serious bleeding events. We observed the increased use of NOAC, with more minor bleeding than with AVK.