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Published on: February 26, 2013
Risk profiles and pattern of antithrombotic use in patients with non-valvular atrial fibrillation in Thailand: a
Rungroj Krittayaphong1, Arjbordin Winijkul2, Komsing Methavigul3
1Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand. rungroj.kri@mahidol.ac.th.
Insights
Anticoagulation therapy is widely used for stroke prevention in Thai patients with non-valvular atrial fibrillation (NVAF). Warfarin remains common, but non-vitamin K antagonist oral anticoagulants (NOACs) use is increasing.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Anticoagulation is standard for stroke prevention in non-valvular atrial fibrillation (NVAF) patients with stroke risk factors.
- Anticoagulants increase bleeding risk, particularly in Asian populations.
- This study investigates risk profiles and antithrombotic use patterns in Thai NVAF patients.
Purpose of the Study:
- To assess risk profiles of NVAF patients in Thailand.
- To analyze antithrombotic prescribing patterns.
- To identify reasons for warfarin non-use in eligible patients.
Main Methods:
- A nationwide multicenter registry including 3218 NVAF patients from 24 Thai hospitals.
- Data collection included demographics, AF details, comorbidities, antithrombotic use, and reasons for warfarin exclusion.
- Data were recorded via case record forms and transferred to a web-based system.
Main Results:
- Average patient age was 67.3 years; 58.2% were male.
- Mean CHA2DS2-VASc score was 3.0. Anticoagulant use was 75.3%; antiplatelet use was 26.5%.
- Reasons for not using warfarin (CHA2DS2-VASc ≥2) included prior antiplatelet use (26.6%), patient preference (23.1%), and NOAC use (22.7%). NOAC use rose from 1.9% (2014) to 25.6% (2017).
Conclusions:
- Anticoagulation was prescribed to 75.3% of NVAF patients.
- Warfarin was used by 90.9% of patients on anticoagulation, while NOACs were used by 9.1%.
- The utilization of NOACs in NVAF patients has shown a significant upward trend over time.
Background:
Anticoagulation therapy is a standard treatment for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) that have risk factors for stroke. However, anticoagulant increases the risk of bleeding, especially in Asians. We aimed to investigate the risk profiles and pattern of antithrombotic use in patients with NVAF in Thailand, and to study the reasons for not using warfarin in this patient population.
Methods:
A nationwide multicenter registry of patients with NVAF was created that included data from 24 hospitals located across Thailand. Demographic data, atrial fibrillation-related data, comorbid conditions, use of antithrombotic drugs, and reasons for not using warfarin were collected. Data were recorded in a case record form and then transferred into a web-based system.
Results:
A total of 3218 patients were included. Average age was 67.3 ± 11.3 years, and 58.2% were male. Average CHADS2, CHA2DS2-VASc, and HAS-BLED score was 1.8 ± 1.3, 3.0 ± 1.7, and 1.5 ± 1.0, respectively. Antiplatelet was used in 26.5% of patients, whereas anticoagulant was used in 75.3%. The main reasons for not using warfarin in those with CHA2DS2-VASc ≥2 included already taking antiplatelet (26.6%), patient preference (23.1%), and using non-vitamin K antagonist oral anticoagulants (NOACs) (22.7%). Anticoagulant was used in 32.3% of CHA2DS2-VASc 0, 56.8% of CHA2DS2-VASc 1, and 81.6% of CHA2DS2-VASc ≥2. The use of NOACs increased from 1.9% in 2014 to 25.6% in 2017.
Conclusions:
Anticoagulation therapy was prescribed in 75.3% of patients with NVAF. Among those receiving anticoagulant, 90.9% used warfarin and 9.1% used NOACs. The use of NOACs increased over time.
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