Vol 28, No 6 (2021)
Original Article
Published online: 2019-07-08

open access

Page views 7472
Article views/downloads 1340
Get Citation

Connect on Social Media

Connect on Social Media

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

Iwona Gorczyca12, Anna Michalska2, Magdalena Chrapek3, Olga Jelonek1, Paweł Wałek1, Beata Wożakowska-Kapłon12
Pubmed: 31313276
Cardiol J 2021;28(6):896-904.


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 (odds ratio [OR] 0.4, 95% confidence interval [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.

Article available in PDF format

View PDF Download PDF file


  1. January C, Wann L, Alpert J, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Circulation. 2014; 130(23).
  2. Cheng TO. Reduced risk for thromboembolism in atrial fibrillation and mitral regurgitation. Am Heart J. 1999; 138(5 Pt 1): 998–999.
  3. Wendelboe AM, Raskob GE. Global burden of thrombosis: epidemiologic aspects. Circ Res. 2016; 118(9): 1340–1347.
  4. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. Arch Intern Med. 1987; 147(9): 1561–1564.
  5. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991; 22(8): 983–988.
  6. Hijazi Z, Lindbäck J, Alexander JH, et al. ARISTOTLE and STABILITY Investigators. The ABC (age, biomarkers, clinical history) stroke risk score: a biomarker-based risk score for predicting stroke in atrial fibrillation. Eur Heart J. 2016; 37(20): 1582–1590.
  7. Kailas SD, Thambuluru SR. Efficacy and safety of direct oral anticoagulants compared to warfarin in prevention of thromboembolic events among elderly patients with atrial fibrillation. Cureus. 2016; 8(10): e836.
  8. Connolly S, Ezekowitz M, Yusuf S, et al. Dabigatran versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2009; 361(12): 1139–1151.
  9. Patel M, Mahaffey K, Garg J, et al. Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. N Engl J Med. 2011; 365(10): 883–891.
  10. Granger C, Alexander J, McMurray J, et al. Apixaban versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2011; 365(11): 981–992.
  11. Giugliano R, Ruff C, Braunwald E, et al. Edoxaban versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med. 2013; 369(22): 2093–2104.
  12. Kirchhof P, Ammentorp B, Darius H, et al. Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events--European Registry in Atrial Fibrillation (PREFER in AF). Europace. 2014; 16(1): 6–14.
  13. Huisman MV, Rothman KJ, Paquette M, et al. The Changing Landscape for Stroke Prevention in AF: Findings From the GLORIA-AF Registry Phase 2. J Am Coll Cardiol. 2017; 69(7): 777–785.
  14. Stępińska J, Kremis E, Konopka A, et al. Stroke prevention in atrial fibrillation patients in Poland and other European countries: insights from the GARFIELD-AF registry. Kardiol Pol. 2016; 74(4): 362–371.
  15. Shantsila E, Wolff A, Lip GYH, et al. Optimising stroke prevention in patients with atrial fibrillation: application of the GRASP-AF audit tool in a UK general practice cohort. Br J Gen Pract. 2015; 65(630): e16–e23.
  16. Lopatowska P, Tomaszuk-Kazberuk A, Mlodawska E, et al. Do CHA2 DS2 VASc and HAS-BLED scores influence 'real-world' anticoagulation management in atrial fibrillation? 1556 patient registry from the reference cardiology centre. Pharmacoepidemiol Drug Saf. 2015; 24(12): 1297–1303.
  17. Kirchhof P, Benussi S, Kotecha D, et al. ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37(38): 2893–2962.
  18. Mazurek M, Huisman MV, Lip GYH. Registries in atrial fibrillation: from trials to real-life clinical practice. Am J Med. 2017; 130(2): 135–145.
  19. Mazurek M, Shantsila E, Lane DA, et al. Guideline-Adherent antithrombotic treatment improves outcomes in patients with atrial fibrillation: insights from the community-based darlington atrial fibrillation registry. Mayo Clin Proc. 2017; 92(8): 1203–1213.
  20. Mazurek M, Shantsila E, Lane DA, et al. Secondary versus primary stroke prevention in atrial fibrillation: insights from the darlington atrial fibrillation registry. Stroke. 2017; 48(8): 2198–2205.
  21. Yoshimura S, Koga M, Sato S, et al. Two-Year Outcomes of Anticoagulation for Acute Ischemic Stroke With Nonvalvular Atrial Fibrillation - SAMURAI-NVAF Study. Circ J. 2018; 82(7): 1935–1942.
  22. Seiffge DJ, Traenka C, Polymeris A, et al. Early start of DOAC after ischemic stroke: Risk of intracranial hemorrhage and recurrent events. Neurology. 2016; 87(18): 1856–1862.
  23. Polymeris AA, Traenka C, Hert L, et al. Frequency and Determinants of Adherence to Oral Anticoagulants in Stroke Patients with Atrial Fibrillation in Clinical Practice. Eur Neurol. 2016; 76(3-4): 187–193.
  24. Gorczyca I, Wożakowska-Kapłon B, Starzyk K, et al. Evaluation of the recommended prevention of thrombosis in hospitalised patients with atrial fibrillation and high thromboembolism risk. Kardiol Pol. 2018; 76(3): 625–632.
  25. Olesen JB, Sørensen R, Hansen ML, et al. Non-vitamin K antagonist oral anticoagulation agents in anticoagulant naïve atrial fibrillation patients: Danish nationwide descriptive data 2011-2013. Europace. 2015; 17(2): 187–193.