Highlights
- •The patterns of “real world” usage of NOACs-patients were compared to VKAs-patients.
- •NOAC agents were used in higher risk patients both for stroke and bleeding.
- •Reduced dose of NOACs were prescribed in a large percentage of patients.
Abstract
Background
Current guidelines recommend vitamin K antagonists (VKAs) or non-vitamin K antagonist
oral anticoagulants (NOACs) for stroke prevention in patients with non-valvular atrial
fibrillation (AF).
Methods
We compared the clinical features of consecutive in- and out-patients with non-valvular
AF newly-treated with NOACs or on treatment with VKAs.
Results
Overall, 1314 patients newly-treated with NOACs and 1024 on treatment with VKAs were
included in the study. The mean CHA2DS2-VASc score was 4.3 ± 1.5 and 4.0 ± 1.5 and the mean HAS-BLED score was 2.8 ± 1.2 and 2.2 ± 1.1 in the two groups, respectively (both p < 0.001). Hypertension, previous stroke, female gender, vascular diseases and previous
bleeding were more prevalent in NOACs patients. Renal failure, age ≥75 years and congestive heart failure were more prevalent in VKAs patients. Among NOACs
patients, 438 were given dabigatran, 463 rivaroxaban and 413 apixaban (33%, 35% and
31%, respectively). The mean CHA2DS2-VASc and HAS-BLED scores were higher in rivaroxaban or apixaban patients compared
with dabigatran (both p < 0.001) and VKAs patients (both p < 0.001). A lower mean age was observed in patients newly-treated with dabigatran. Patients
newly-treated with reduced doses of NOACs (599 patients, 45.5%) had a higher CHA2DS2-VASc (4.8 ± 1.4 vs. 3.9 ± 1.5 vs. 4.0 ± 1.5) and HAS-BLED (2.9 ± 1.1 vs. 2.8 ± 1.2 vs. 2.2 ± 1.1) scores compared with those treated with regular doses of NOACs or VKAs.
Conclusion
Patients given rivaroxaban and apixaban in clinical practice have a higher thrombotic
and hemorrhagic risk in comparison with patients given dabigatran or VKAs. A considerable
proportion of patients receive reduced doses of NOACs.
Keywords
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Article info
Publication history
Published online: July 06, 2016
Accepted:
June 16,
2016
Received in revised form:
June 15,
2016
Received:
March 30,
2016
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.