Demographic, clinical, and functional determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation
Por:
Mostaza, JM, Suarez, C, Cepeda, JM, Manzano, L, Sanchez, D, Mascaró J., Maestre Peiro, Ana
Publicada:
9 ago 2021
Resumen:
Background This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting. Methods A multicenter, cross-sectional study was conducted in NVAF patients who attended internal medicine departments for either a routine visit (outpatients) or hospitalization (inpatients). Results A total of 961 patients were evaluated. Their antithrombotic management included: no treatment (4.7%), vitamin K antagonists (VKAs) (59.6%), direct oral anticoagulants (DOACs) (21.6%), antiplatelets (6.6%), and antiplatelets plus anticoagulants (7.5%). Permanent NVAF and congestive heart failure were associated with preferential use of oral anticoagulation over antiplatelets, while intermediate-to high-mortality risk according to the PROFUND index was associated with a higher likelihood of using antiplatelet therapy instead of oral anticoagulation. Longer disease duration and institutionalization were identified as determinants of VKA use over DOACs. Female gender, higher education, and having suffered a stroke determined a preferential use of DOACs. Conclusions This real-world study showed that most elderly NVAF patients received oral anticoagulation, mainly VKAs, while DOACs remained underused. Antiplatelets were still offered to a proportion of patients. Longer duration of NVAF and institutionalization were identified as determinants of VKA use over DOACs. A poor prognosis according to the PROFUND index was identified as a factor preventing the use of oral anticoagulation.
Filiaciones:
Mostaza, JM:
Hosp Carlos III, Dept Internal Med, Calle Sinesio Delgado 10, Madrid 28029, Spain
Suarez, C:
Hosp Univ Princesa, Dept Internal Med, Madrid, Spain
Cepeda, JM:
Hosp Vega Baja, Dept Internal Med, Alicante, Spain
Manzano, L:
Univ Alcala De Henares, Hosp Ramon Y Cajal, Ramon Y Cajal Hlth Res Inst IRYCIS, Dept Internal Med, Madrid, Spain
Sanchez, D:
Hosp Nuestra Senora Sonsoles, Dept Internal Med, Avila, Spain
Mascaró J.:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Maestre Peiro, Ana:
Hospital del Vinalopó, Elche, Alicante, Spain
Green Published, gold
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