Profiling of patients with non-valvular atrial fibrillation and moderate-to-high risk of stroke not receiving oral anticoagulation in Spain

• Published in: Semergen, medicina de familia Vol. 45; no. 6; pp. 396 - 405
• Main Authors: Polo García, J, Vargas Ortega, D, Formiga, F, Unzueta, I, Fernández de Cabo, S, Chaves, J
• Format: Journal Article
• Language: English
• Published: Spain Elsevier España, S.L.U 01.09.2019
• Subjects: Administration, Oral; Adult; Aged; Aged, 80 and over; Anticoagulantes; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Antiplatelet drugs; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Cross-Sectional Studies; Female; Fibrilación auricular; Fármacos antiagregantes; Hemorrhage - chemically induced; Humans; Internal Medicine; Male; Middle Aged; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Practice Patterns, Physicians' - statistics & numerical data; Prevalence; Prevalencia; Reducción del riesgo; Retrospective Studies; Risk Factors; Risk reduction; Spain; Stroke - etiology; Stroke - prevention & control; Thromboembolism - etiology; Thromboembolism - prevention & control; Spain; Anticoagulants; Prevalence; Prevalencia; Atrial fibrillation; Fármacos antiagregantes; Anticoagulantes; Risk reduction; Antiplatelet drugs; Fibrilación auricular; Reducción del riesgo
• ISSN: 1138-3593; 1578-8865
• DOI: 10.1016/j.semerg.2018.10.005

Abstract Objective In non-valvular atrial fibrillation (NVAF) with embolic risk, the guidelines recommend oral anticoagulation (OAC), although not all patients receive it. In this study, an attempt is made to identify these patients, and to study factors related to non-anticoagulation. Material and methods Non-interventional, cross-sectional, multicentre study was performed on a population of patients ≥18 years with a NVAF diagnosis, moderate-high embolic risk (CHADS2 score ≥ 2), not treated with OAC. Atrial fibrillation (AF) prevalence was also collected. Results AF prevalence was 4.5%, and 80.7% of the patients had NVAF (20.0% did not receive OAC). A total of 1310 non-OAC-treated patients were included (51.8% male, mean age: 76.0 years). The mean time since AF diagnosis was 58.4 months. The main therapeutic decision for stroke prevention was prescription of antiplatelet agents (82.4%, n = 1078), and the main reasons were: patient refusal to monitoring (37.3%), high bleeding risk (31.1%), uncontrolled hypertension (27.9%), and frequent falls (27.6%). The mean CHA2 DS2 -VASc score was 4.6, and the HAS-BLED was 2.7 (55.9% of patients scoring HAS-BLED ≥ 3). The most common thromboembolic risk factors were: hypertension (89.1%), age ≥ 75 years (61.5%); the haemorrhagic factors: use of drugs increasing the bleeding risk (41.2%), uncontrolled blood pressure (33.7%). Conclusions About 20% of Spanish NVAF patients do not receive OAC in the clinical practice and are treated with antiplatelet agents, which do not reduce haemorrhagic risk. Most patients do not clearly show a contraindication to OACs, particularly considering that there are other available options (direct oral anticoagulant drugs [DOACs]).