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Published online: 2019-07-08
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Non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation in secondary stroke and systemic embolism prevention

Iwona Gorczyca, Anna Michalska, Magdalena Chrapek, Olga Jelonek, Paweł Wałek, Beata Wożakowska-Kapłon
DOI: 10.5603/CJ.a2019.0069
·
Pubmed: 31313276

open access

Ahead of print
Original articles
Published online: 2019-07-08

Abstract

Background: Oral anticoagulants (OAC) are recommended in all patients with atrial fibrillation (AF) after thromboembolic events without contraindications. It is hypothesized herein, that the majority of patients with AF after thromboembolic events receive OAC and the presence of specific factors, predisposes the use of non-vitamin K antagonist oral anticoagulants (NOACs).

Methods: This is a retrospective study, encompassing patients with AF hospitalized in a reference cardiology center over the years 2014–2017. Thromboembolic events were defined as: ischemic stroke, transient ischemic attack and systemic embolism. Inclusion criteria were the following: diagnosis of non-valvular AF at discharge from hospital, hospitalization not resulting in death.

Results: Among 2834 hospitalized patients with AF, a history of thromboembolic events was identified in 347 (12.2%) patients. In the group studied, of 347 patients with AF after a thromboembolic event, 322 (92.8%) received OAC, including 133 patients on vitamin K antagonist (41.3% of patients on OAC) and 189 patients on NOACs (58.7% of patients on OAC). Among patients treated with NOACs the majority were on dabigatran (116 patients, 61.4%), followed by rivaroxaban (54 patients, 28.6%), and apixaban (19 patients, 10%). Multivariate logistic regression analysis demonstrated that the presence of arterial hypertension reduced the chance for NOACs use (OR 0.4, 95% CI 0.2–0.9, p = 0.04) and left atrial size ≤ 40 mm was a factor increasing the chance for the use of NOACs (OR 2.5, 95% CI 1.1–5.8, p = 0.03).

Conclusions: Nearly all hospitalized patients with AF received OAC in the secondary prevention of thromboembolic complications. NOACs were used for secondary prevention of stroke among patients with AF in patients with fewer comorbidities.

Abstract

Background: Oral anticoagulants (OAC) are recommended in all patients with atrial fibrillation (AF) after thromboembolic events without contraindications. It is hypothesized herein, that the majority of patients with AF after thromboembolic events receive OAC and the presence of specific factors, predisposes the use of non-vitamin K antagonist oral anticoagulants (NOACs).

Methods: This is a retrospective study, encompassing patients with AF hospitalized in a reference cardiology center over the years 2014–2017. Thromboembolic events were defined as: ischemic stroke, transient ischemic attack and systemic embolism. Inclusion criteria were the following: diagnosis of non-valvular AF at discharge from hospital, hospitalization not resulting in death.

Results: Among 2834 hospitalized patients with AF, a history of thromboembolic events was identified in 347 (12.2%) patients. In the group studied, of 347 patients with AF after a thromboembolic event, 322 (92.8%) received OAC, including 133 patients on vitamin K antagonist (41.3% of patients on OAC) and 189 patients on NOACs (58.7% of patients on OAC). Among patients treated with NOACs the majority were on dabigatran (116 patients, 61.4%), followed by rivaroxaban (54 patients, 28.6%), and apixaban (19 patients, 10%). Multivariate logistic regression analysis demonstrated that the presence of arterial hypertension reduced the chance for NOACs use (OR 0.4, 95% CI 0.2–0.9, p = 0.04) and left atrial size ≤ 40 mm was a factor increasing the chance for the use of NOACs (OR 2.5, 95% CI 1.1–5.8, p = 0.03).

Conclusions: Nearly all hospitalized patients with AF received OAC in the secondary prevention of thromboembolic complications. NOACs were used for secondary prevention of stroke among patients with AF in patients with fewer comorbidities.

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Keywords

atrial fibrillation, oral anticoagulants, secondary prevention, stroke, thromboembolic event

About this article
Title

Non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation in secondary stroke and systemic embolism prevention

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Research paper

Published online

2019-07-08

DOI

10.5603/CJ.a2019.0069

Pubmed

31313276

Keywords

atrial fibrillation
oral anticoagulants
secondary prevention
stroke
thromboembolic event

Authors

Iwona Gorczyca
Anna Michalska
Magdalena Chrapek
Olga Jelonek
Paweł Wałek
Beata Wożakowska-Kapłon

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