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Updated: Mar 1, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Real-practice thromboprophylaxis in atrial fibrillation
Insights
Vitamin K antagonist (VKA) use for nonvalvular atrial fibrillation (NVAF) is suboptimal in Italy, with many patients undertreated or not at target. Oral anticoagulation treatment (OAT) remains effective but requires better guideline adherence.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Nonvalvular atrial fibrillation (NVAF) management requires effective oral anticoagulation treatment (OAT).
- Vitamin K antagonists (VKAs) are a common OAT, but their real-world utilization and effectiveness are under scrutiny.
- Current guidelines exist for OAT in NVAF, yet adherence in clinical practice may vary.
Purpose of the Study:
- To evaluate the prevalence of OAT use in NVAF patients.
- To assess the effectiveness of OAT in managing NVAF in routine clinical practice.
- To identify barriers to VKA treatment and analyze guideline adherence.
Main Methods:
- Retrospective observational study utilizing databases from the Local Health Authority of Treviso, Italy.
- Analysis of 6,138 NVAF patients, focusing on OAT prescription patterns and outcomes.
- Evaluation of factors influencing VKA treatment probability and assessment of anticoagulation target achievement.
Main Results:
- Only 3,024 out of 6,138 NVAF patients received VKA treatment.
- Barriers to VKA use included female sex, older age, antiplatelet therapy, and prior bleeding history.
- VKA treatment deviated from guidelines, with under- and over-treatment observed based on stroke risk; 73% of treated patients were not at therapeutic target.
Conclusions:
- OAT is effective in reducing stroke risk for NVAF patients.
- Significant disparities exist in VKA prescription and adherence to treatment targets in clinical practice.
- Previous stroke/TIA and bleeding events are significant predictors of stroke occurrence, highlighting the need for optimized anticoagulation strategies.
Abstract:
This retrospective observational study was based on databases of the Local Health Authority of Treviso, Italy. It evaluated the prevalence and the effectiveness of oral anticoagulation treatment (OAT) for the management of nonvalvular atrial fibrillation (NVAF) in everyday clinical practice. Out of 6,138 NVAF patients, only 3,024 received vitamin K antagonist (VKA). Potential barriers decreasing the probability of being treated with VKA were female sex, older age, antiplatelet treatment and history of bleeding. In addition, VKA-treatment was not in line with current ESC and AIAC guidelines, since the patients at high or low risk of stroke were under- or over-treated, resp. Among VKAtreated patients, 73 % of subjects were not at target with anticoagulation. OAT resulted to be effective in reducing stroke risk. However, stroke events were significantly influenced also by previous stroke or transient ischemic attack (hazard ratio, HR = 2.99, p < 0.001) and by previous bleeding events (HR = 1.60, p < 0.001).
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