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Published on: February 26, 2013
Current Anticoagulant Usage Patterns and Determinants in Korean Patients with Nonvalvular Atrial Fibrillation
Hyun Su Ha1, Joongmin Kim1, Young Soo Lee2
1Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Insights
Factors like renal disease and cancer influence anticoagulant choice in atrial fibrillation patients. Many patients incorrectly receive antiplatelet agents with oral anticoagulants, increasing bleeding risks.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Atrial fibrillation (AF) necessitates stroke prevention strategies.
- Warfarin and direct oral anticoagulants (OACs) are key antithrombotic agents.
- Understanding factors influencing OAC selection is crucial for effective stroke risk management.
Purpose of the Study:
- To identify variables associated with warfarin versus direct OAC use in AF patients.
- To evaluate the prescribing patterns of OACs and combination antiplatelet therapy.
Main Methods:
- Prospective, multicenter CODE-AF registry analysis.
- Inclusion of 10,529 patients with AF.
- Multivariate analyses to determine factors associated with anticoagulant selection.
Main Results:
- Direct OACs were used in 68.8% of high-stroke-risk patients (CHA₂DS₂-VASc ≥2).
- End-stage renal disease, myocardial infarction, and bleeding history favored warfarin.
- Cancer and smoking were associated with direct OAC preference over warfarin.
- 73.6% of patients received antiplatelets with OACs without guideline indication.
Conclusions:
- Renal disease and valvular heart disease history correlate with warfarin use.
- Cancer and smoking status are linked to direct OAC selection in high-risk AF patients.
- Guideline-discordant combination antiplatelet therapy with OACs is prevalent, posing potential risks.
Purpose:
Stroke prevention in patients with atrial fibrillation (AF) is influenced by many factors. Using a contemporary registry, we evaluated variables associated with the use of warfarin or direct oral anticoagulants (OACs).
Materials And Methods:
In the prospective multicenter CODE-AF registry, 10529 patients with AF were evaluated. Multivariate analyses were performed to identify variables associated with the use of anticoagulants.
Results:
The mean age of the patients was 66.9±14.4 years, and 64.9% were men. The mean CHA₂DS₂-VASc and HAS-BLED scores were 2.6±1.7 and 1.8±1.1, respectively. In patients with high stroke risk (CHA₂DS₂-VASc ≥2), OACs were used in 83.2%, including direct OAC in 68.8%. The most important factors for non-OAC treatment were end-stage renal disease [odds ratio (OR) 0.27; 95% confidence interval (CI): 0.19-0.40], myocardial infarct (OR 0.53; 95% CI: 0.40-0.72), and major bleeding (OR 0.57; 95% CI: 0.39-0.84). Female sex (OR 1.40; 95% CI: 1.21-1.61), cancer (OR 1.78; 95% CI: 1.38-2.29), and smoking (OR 1.60; 95% CI: 1.15-2.24) were factors favoring direct OAC use over warfarin. Among patients receiving OACs, the rate of combined antiplatelet agents was 7.8%. However, 73.6% of patients did not have any indication for a combination of antiplatelet agents.
Conclusion:
Renal disease and history of valvular heart disease were associated with warfarin use, while cancer and smoking status were associated with direct OAC use in high stroke risk patients. The combination of antiplatelet agents with OAC was prescribed in 73.6% of patients without definite indications recommended by guidelines.
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