Real-practice thromboprophylaxis in atrial fibrillation

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.