Direct oral anticoagulants versus vitamin K antagonists in real-world patients with nonvalvular atrial fibrillation. The FANTASIIA study
Por:
Sanchez, MA, Martinez, VB, Ortiza, MR, Fillat, AC, Rabadan, IR, Garcia, JM, Maestro, LB, Pastor, MAE, Ortuno, FM
Publicada:
1 ene 2020
Resumen:
Introduction and objectives: To compare the long-term results of direct oral anticoagulants (DOAC) vs vitamin K antagonists (VKA) in real-world-patients with nonvalvular atrial fibrillation (NVAF) in a nationwide, prospective study.
Methods: The FANTASIIA registry prospectively included outpatients with AF anticoagulated with DOAC or VKA (per protocol, proportion of VKA and DOAC 4:1), consecutively recruited from June 2013 to October 2014 in Spain. The incidence of major events was analyzed and compared according to the anticoagulant treatment received.
Results: A total of 2178 patients were included in the study (mean age 73.8 +/- 9.4 years), and 43.8% were women. Of these, 533 (24.5%) received DOAC and 1645 (75.5%) VKA. After a median follow up of 32.4 months, patients receiving DOAC vs those receiving VKA had lower rates of stroke-0.40 (95%CI, 0.17-0.97) vs 1.07 (95%CI,0.79-1.46) patients/y, P = .032-, severe bleedings-2.13 (95%CI, 1.45-3.13) vs 3.28 (95%CI, 2.75-3.93) patients/y; P = .044-, cardiovascular death-1.20 (95%CI, 0.72-1.99) vs 2.45 (95%CI, 2.00-3.00) patients/y; P = .009-, and all-cause death-3.77 (95%CI, 2.83-5.01) vs 5.54 (95%CI, 4.83-6.34) patients/y; P = .016-. In a modified Cox regression model by the Andersen-Gill method for multiple events, hazard ratios for patients receiving DOAC were: 0.42 (0.16-1.07) for stroke; 0.47 (0.20-1.16) for total embolisms; 0.76 (0.50-1.15) for severe bleedings; 0.67 (0.39-1.18) for cardiovascular death; 0.86 (0.62-1.19) for all-cause death, and 0.82 (0.64-1.05) for the combined event consisting of stroke, embolism, severe bleeding, and all-cause death.
Conclusions: Compared with VKA, DOAC is associated with a trend to a lower incidence of all major events, including death, in patients with NVAF in Spain. (C) 2019 Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Cardiologia.
Filiaciones:
Sanchez, MA:
Hosp Univ Reina Sofia, Serv Cardiol, Avda Menendez Pidal 1, Cordoba 14004, Spain
Martinez, VB:
Hosp Univ San Juan, Serv Cardiol, Alicante, Spain
Ortiza, MR:
Hosp Univ Reina Sofia, Serv Cardiol, Avda Menendez Pidal 1, Cordoba 14004, Spain
Fillat, AC:
Hosp Univ Bellvitge, Serv Cardiol, Barcelona, Spain
Rabadan, IR:
Hosp Univ La Paz, Serv Cardiol, Madrid, Spain
Garcia, JM:
Univ A Coruna, La Coruna, Spain
Maestro, LB:
Hosp Santa Creu & Sant Pau, ICCC, CSIC, Inst Invest Cardiovasc, Barcelona, Spain
Pastor, MAE:
Hosp Univ Virgen Arrixaca, IMIB Arrixaca, CIBERCV, Serv Cardiol, Murcia, Spain
Ortuno, FM:
Hosp Univ Virgen Arrixaca, IMIB Arrixaca, CIBERCV, Serv Cardiol, Murcia, Spain
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