New oral anticoagulants for the prevention of thromboembolic complications in atrial fibrillation: a single centre experience

Abstract

Background: Prevention of thromboembolic complications is a priority in patients with atrial fibrillation (AF). Based on the current guidelines, the role of vitamin K antagonists (VKA) in stroke prevention has decreased in favour of novel oral anticoagulants (NOAC).

Aim: To evaluate the proportion of AF patients who were prescribed a NOAC, compare populations of patients treated with VKA and NOAC, and identify factors predisposing to NOAC prescription at hospital discharge of AF patients.

Methods: A single-centre prospective study was carried out based on medical records of 550 patients who were diagnosed with non-valvular AF and discharged from a Cardiology Department from September 2012 till August 2013.

Results: Among 550 patients with AF, an oral anticoagulant (OAC) was prescribed for stroke prevention in 463 (84.2%) patients. At discharge, VKA was prescribed in 373 patients (80.6% of those treated with OAC), and NOAC was prescribed in 90 patients (19.4% of those treated with OAC). Among patients receiving NOAC, dabigatran was prescribed to 41 (45.6%) patients and rivaroxaban was prescribed to 49 (54.4%) patients. The mean CHA2DS2VASc scores in patients treated with VKA and NOAC were 3.8 ± 1.7 and 4.1 ± 1.7, respectively (p = NS). The mean HASBLED score in patients treated with VKA and NOAC was 2.2 ± 1.0 and 2 ± 0.9, respectively (p = NS). Patients treated with NOAC were older than patients treated with VKA (mean age 74.7 ± 11.9 vs. 70.5 ± 10.8 years, p = 0.0005). In multivariate analysis, factors associated with an increased likelihood of NOAC prescription included a history of bleeding (odds ratio [OR] 3.43), hospitalisation due to AF (OR 2.82), age ≥ 80 years (OR 2.8), paroxysmal arrhythmia (OR 1.77), and living in a rural area (OR 1.77).

Conclusions: A NOAC was used in one fifth of all hospitalised AF patients receiving anticoagulant treatment. The risk of thromboembolic and bleeding complications did not differ between AF patients treated with NOAC or VKA. Factors associated with an increased likelihood of NOAC prescription included a history of bleeding, age ≥ 80 years, paroxysmal arrhythmia, hospitalisation due to AF, and living in a rural area.