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Lights and shadows in the management of old and new oral anticoagulants in the real world of atrial fibrillation by Italian internists. A survey from the Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study

  • Pasquale Pignatelli
    Affiliations
    I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
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  • Daniele Pastori
    Affiliations
    I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
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  • Francesco Perticone
    Affiliations
    Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy
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  • Gino R. Corazza
    Affiliations
    First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
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  • Francesco Violi
    Correspondence
    Corresponding author at: I Clinica Medica, Viale del Policlinico 155, Roma, 00161, Italy. Tel.: +39 064461933; fax: +39 0649970103.
    Affiliations
    I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy
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  • on behalf of the ARAPACIS (Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study) Study group
    Author Footnotes
    1 APPENDIXCOLLABORATORSCominacini Luciano, Mozzini Chiara (Dipartimento di Medicina, Sezione di Medicina Interna D, Università di Verona); De Palma Daniela, Galderisi Maurizio, Cudemo Giuseppe (Dipartimento di Medicina Clinica e Sperimentale, AUP Federico II di Napoli); Galletti Ferruccio, Fazio Valeria(Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II); Adinolfi Luigi Elio, Sellitto Ausilia, Restivo Luciano (Medicina Interna, Seconda Università di Napoli, Ospedale di Marcianise); Cacciafesta Mauro, Gueli Nicola (UOC di Medicina Geriatrica e Riabilitazione, Sapienza-Università di Roma, Roma); Castellino Pietro, Curto Irene, Vecchio Claudia (UOC Medicina Interna, Dipartimento di Scienze Mediche e Pediatriche, Università degli Studi di Catania); Sesti Giorgio, Arturi Franco, Grembiale Alessandro (Università degli Studi “Magna Graecia”, UOC Medicina Interna, Policlinico Universitario “Mater Domini”); Perticone Francesco, Scarpino Paola Elisa, Carullo Giuseppe (Cattedra di Medicina Interna, UO Malattie Cardiovascolari, Campus Universitario di Germaneto, Università Magna Graecia di Catanzaro); Vidili Gianpaolo, Atzori Sebastiana, Delitala Giuseppe (Clinica Medica, Dipartimento di Medicina Clinica e Sperimentale, AOU Sassari); Di Michele Dario, Fava Alessandra (UOC Medicina Interna, Ospedale “G.Mazzini”, ASL Teramo); Bertolotti Marco, Mussi Chiara (UO Geriatria, Dipartimento Integrato di Medicina Endocrinologia Metabolismo e Geriatria. Università degli Studi di Modena e Reggio Emilia); De Luca Elisabetta, De Zaiacomo Francesca, Giantin Valter (Clinica Geriatrica, Dipartimento di Medicina, Università di Padova); Corazza Gino Roberto, Miceli Emanuela, Padula Donatella (Clinica Medica I, Reparto 11, IRCCS Policlinico San Matteo di Pavia, Pavia); Santovito Donato, Cipollone Francesco (Centro di Eccellenza Europeo e di Riferimento Regionale per l'Aterosclerosi, l'Ipertensione Arteriosa e le Dislipidemie, Università “G. d'Annunzio”, Chieti); Andreozzi Paola, Ettorre Evaristo, Viscogliosi Giovanni (Area Geriatria, DAI Medicina Interna, Sapienza-Università di Roma, Roma); Glorioso Nicola, Melis Giada, Marras Gianfranca, Matta Michela (Ambulatorio Ipertensione Arteriosa e Patologie Correlate, AOU Sassari, Sassari); Porta Massimo, Brizzi Maria Felice (SC Medicina Interna 1U, Azienda Ospedaliera “Città della Salute e della Scienza”, Torino); Moroni Carlo, Valente Lucia, Lopreiato Francesco (Laboratorio di Ecocardiografia-Cardiologia Preventiva, DAI Cuore e Grossi Vasi, Sapienza-Università di Roma, Roma); Gentile Adelina, Catozzo Vania (UO Medicina, LDP Loreto, Dipartimento di Medicina Interna,ASUR Marche, Area Vasta n.2, ex ZT 7); Rancan Elena, Ageno Walter, Guasti Luigina (Dipartimento di Medicina Clinica e Sperimentale, Università dell'Insubria, Varese);Cangemi Roberto, Pignataro Francesca Serena, Pastori Daniele, Ferro Domenico, Loffredo Lorenzo, Perri Ludovica, Catasca Elisa, Raparelli Valeria, Napoleone Laura, Tommaso Bucci, Francesco Baratta, Talerico Giovanni, Calvieri Camilla, Vicario Tommasa, Russo Roberta, Saliola Mirella, Del Ben Maria, Angelico Francesco (I Clinica Medica, Sapienza-Università di Roma).DATA AND SAFETY MONITORING BOARD (DSMB): VESTRI Anna Rita, FARCOMENI Alessio, DI TANNA Gianluca (Department of Public Health and Infectious Disease- SAPIENZA University of Rome, Italy)STUDY COORDINATORS: DAVI’ Giovanni (Internal Medicine, University of Chieti, Italy), BASILI Stefania (I Clinica Medica, Sapienza University of Rome, Italy).STEERING COMMITTEE OF ARAPACIS STUDY: MANNUCCI Pier Mannuccio (Foundation IRCCS Ca' Granda Ospedale Maggiore-Milano, Italy), PERTICONE Francesco (University of Catanzaro, Italy), LIP Gregory YH (University of Birmingham Centre for Cardiovascular Sciences, UK), HIATT William (University of Colorado School of Medicine, Division of Cardiology, Aurora, CO), VESTRI Anna Rita (Department of Public Health and Infectious Disease- SAPIENZA University of Rome, Italy), CORAZZA Gino Roberto (First Dept of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy), LICATA Giuseppe (Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy).ITALIAN INTERNAL MEDICINE SOCIETY (SIMI) INDIPENDENT RESEARCH CENTER [CRIS]: Violi Francesco, Gobbi Paolo, Basili Stefania, Corrao Salvatore.
  • Author Footnotes
    1 APPENDIXCOLLABORATORSCominacini Luciano, Mozzini Chiara (Dipartimento di Medicina, Sezione di Medicina Interna D, Università di Verona); De Palma Daniela, Galderisi Maurizio, Cudemo Giuseppe (Dipartimento di Medicina Clinica e Sperimentale, AUP Federico II di Napoli); Galletti Ferruccio, Fazio Valeria(Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II); Adinolfi Luigi Elio, Sellitto Ausilia, Restivo Luciano (Medicina Interna, Seconda Università di Napoli, Ospedale di Marcianise); Cacciafesta Mauro, Gueli Nicola (UOC di Medicina Geriatrica e Riabilitazione, Sapienza-Università di Roma, Roma); Castellino Pietro, Curto Irene, Vecchio Claudia (UOC Medicina Interna, Dipartimento di Scienze Mediche e Pediatriche, Università degli Studi di Catania); Sesti Giorgio, Arturi Franco, Grembiale Alessandro (Università degli Studi “Magna Graecia”, UOC Medicina Interna, Policlinico Universitario “Mater Domini”); Perticone Francesco, Scarpino Paola Elisa, Carullo Giuseppe (Cattedra di Medicina Interna, UO Malattie Cardiovascolari, Campus Universitario di Germaneto, Università Magna Graecia di Catanzaro); Vidili Gianpaolo, Atzori Sebastiana, Delitala Giuseppe (Clinica Medica, Dipartimento di Medicina Clinica e Sperimentale, AOU Sassari); Di Michele Dario, Fava Alessandra (UOC Medicina Interna, Ospedale “G.Mazzini”, ASL Teramo); Bertolotti Marco, Mussi Chiara (UO Geriatria, Dipartimento Integrato di Medicina Endocrinologia Metabolismo e Geriatria. Università degli Studi di Modena e Reggio Emilia); De Luca Elisabetta, De Zaiacomo Francesca, Giantin Valter (Clinica Geriatrica, Dipartimento di Medicina, Università di Padova); Corazza Gino Roberto, Miceli Emanuela, Padula Donatella (Clinica Medica I, Reparto 11, IRCCS Policlinico San Matteo di Pavia, Pavia); Santovito Donato, Cipollone Francesco (Centro di Eccellenza Europeo e di Riferimento Regionale per l'Aterosclerosi, l'Ipertensione Arteriosa e le Dislipidemie, Università “G. d'Annunzio”, Chieti); Andreozzi Paola, Ettorre Evaristo, Viscogliosi Giovanni (Area Geriatria, DAI Medicina Interna, Sapienza-Università di Roma, Roma); Glorioso Nicola, Melis Giada, Marras Gianfranca, Matta Michela (Ambulatorio Ipertensione Arteriosa e Patologie Correlate, AOU Sassari, Sassari); Porta Massimo, Brizzi Maria Felice (SC Medicina Interna 1U, Azienda Ospedaliera “Città della Salute e della Scienza”, Torino); Moroni Carlo, Valente Lucia, Lopreiato Francesco (Laboratorio di Ecocardiografia-Cardiologia Preventiva, DAI Cuore e Grossi Vasi, Sapienza-Università di Roma, Roma); Gentile Adelina, Catozzo Vania (UO Medicina, LDP Loreto, Dipartimento di Medicina Interna,ASUR Marche, Area Vasta n.2, ex ZT 7); Rancan Elena, Ageno Walter, Guasti Luigina (Dipartimento di Medicina Clinica e Sperimentale, Università dell'Insubria, Varese);Cangemi Roberto, Pignataro Francesca Serena, Pastori Daniele, Ferro Domenico, Loffredo Lorenzo, Perri Ludovica, Catasca Elisa, Raparelli Valeria, Napoleone Laura, Tommaso Bucci, Francesco Baratta, Talerico Giovanni, Calvieri Camilla, Vicario Tommasa, Russo Roberta, Saliola Mirella, Del Ben Maria, Angelico Francesco (I Clinica Medica, Sapienza-Università di Roma).DATA AND SAFETY MONITORING BOARD (DSMB): VESTRI Anna Rita, FARCOMENI Alessio, DI TANNA Gianluca (Department of Public Health and Infectious Disease- SAPIENZA University of Rome, Italy)STUDY COORDINATORS: DAVI’ Giovanni (Internal Medicine, University of Chieti, Italy), BASILI Stefania (I Clinica Medica, Sapienza University of Rome, Italy).STEERING COMMITTEE OF ARAPACIS STUDY: MANNUCCI Pier Mannuccio (Foundation IRCCS Ca' Granda Ospedale Maggiore-Milano, Italy), PERTICONE Francesco (University of Catanzaro, Italy), LIP Gregory YH (University of Birmingham Centre for Cardiovascular Sciences, UK), HIATT William (University of Colorado School of Medicine, Division of Cardiology, Aurora, CO), VESTRI Anna Rita (Department of Public Health and Infectious Disease- SAPIENZA University of Rome, Italy), CORAZZA Gino Roberto (First Dept of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy), LICATA Giuseppe (Dipartimento Biomedico di Medicina Interna e Specialistica, Università degli Studi di Palermo, Italy).ITALIAN INTERNAL MEDICINE SOCIETY (SIMI) INDIPENDENT RESEARCH CENTER [CRIS]: Violi Francesco, Gobbi Paolo, Basili Stefania, Corrao Salvatore.
      Atrial fibrillation (AF) is the most frequent cardiac arrhythmia, which is associated with an enhanced risk for stroke and myocardial infarction [
      • Pastori D.
      • Pignatelli P.
      • Angelico F.
      • Farcomeni A.
      • Del Ben M.
      • Vicario T.
      • et al.
      Incidence of myocardial infarction and vascular death in anticoagulated elderly patients with atrial fibrillation: Relation to atherosclerotic risk factors.
      ,
      • Benjamin E.J.
      • Wolf P.A.
      • D'Agostino R.B.
      • Silbershatz H.
      • Kannel W.B.
      • Levy D.
      Impact of atrial fibrillation on the risk of death: the Framingham Heart Study.
      ,
      • Soliman E.Z.
      • Safford M.M.
      • Muntner P.
      • Khodneva Y.
      • Dawood F.Z.
      • Zakai N.A.
      • et al.
      Atrial fibrillation and the risk of myocardial infarction.
      ]. Vitamin K antagonists (VKAs) have been the golden standard for stroke prophylaxis but they are associated with a significant risk of bleeding [
      • Lip G.Y.
      • Andreotti F.
      • Fauchier L.
      • Huber K.
      • Hylek E.
      • Knight E.
      • et al.
      Bleeding risk assessment and management in atrial fibrillation patients: a position document from the European Heart Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis.
      ]. VKAs are unsuitable for many patients, due to difficulties related to the frequent need for check of INR values, or to difficulties in achieving and maintaining an adequate Time in Therapeutic Range (TTR). Non-vitamin K oral anticoagulants (NOACs), inhibiting activated Factor X or prothrombin, represent a valid alternative, as they showed similar efficacy to VKAs with a safer profile [
      • Ruff C.T.
      • Giugliano R.P.
      • Braunwald E.
      • Hoffman E.B.
      • Deenadayalu N.
      • Ezekowitz M.D.
      • et al.
      Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials.
      ], without the need for frequent laboratory monitoring [
      • Heidbuchel H.
      • Verhamme P.
      • Alings M.
      • Antz M.
      • Hacke W.
      • Oldgren J.
      • et al.
      European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation.
      ,
      • Camm A.J.
      • Lip G.Y.
      • De Caterina R.
      • Savelieva I.
      • Atar D.
      • Hohnloser S.H.
      • et al.
      2012 Focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association.
      ].

      Keywords

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      References

        • Pastori D.
        • Pignatelli P.
        • Angelico F.
        • Farcomeni A.
        • Del Ben M.
        • Vicario T.
        • et al.
        Incidence of myocardial infarction and vascular death in anticoagulated elderly patients with atrial fibrillation: Relation to atherosclerotic risk factors.
        Chest. 2015; 147: 1644-1650
        • Benjamin E.J.
        • Wolf P.A.
        • D'Agostino R.B.
        • Silbershatz H.
        • Kannel W.B.
        • Levy D.
        Impact of atrial fibrillation on the risk of death: the Framingham Heart Study.
        Circulation. 1998; 98: 946-952
        • Soliman E.Z.
        • Safford M.M.
        • Muntner P.
        • Khodneva Y.
        • Dawood F.Z.
        • Zakai N.A.
        • et al.
        Atrial fibrillation and the risk of myocardial infarction.
        JAMA Int Med. 2014; 174: 107-114
        • Lip G.Y.
        • Andreotti F.
        • Fauchier L.
        • Huber K.
        • Hylek E.
        • Knight E.
        • et al.
        Bleeding risk assessment and management in atrial fibrillation patients: a position document from the European Heart Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis.
        Europace. 2011; 13: 723-746
        • Ruff C.T.
        • Giugliano R.P.
        • Braunwald E.
        • Hoffman E.B.
        • Deenadayalu N.
        • Ezekowitz M.D.
        • et al.
        Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials.
        Lancet. 2014; 383: 955-962
        • Heidbuchel H.
        • Verhamme P.
        • Alings M.
        • Antz M.
        • Hacke W.
        • Oldgren J.
        • et al.
        European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation.
        Europace. 2013; 15: 625-651
        • Camm A.J.
        • Lip G.Y.
        • De Caterina R.
        • Savelieva I.
        • Atar D.
        • Hohnloser S.H.
        • et al.
        2012 Focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association.
        Eur Heart J. 2012; 33: 2719-2747
        • Gallagher A.M.
        • Setakis E.
        • Plumb J.M.
        • Clemens A.
        • van Staa T.P.
        Risks of stroke and mortality associated with suboptimal anticoagulation in atrial fibrillation patients.
        J Thromb Haemost. 2011; 106: 968-977
        • Kakkar A.K.
        • Mueller I.
        • Bassand J.P.
        • Fitzmaurice D.A.
        • Goldhaber S.Z.
        • Goto S.
        • et al.
        Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry.
        PLoS One. 2013; 8: e63479
        • Kirchhof P.
        • Ammentorp B.
        • Darius H.
        • De Caterina R.
        • Le Heuzey J.Y.
        • Schilling R.J.
        • 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: 6-14