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Adherence to Anticoagulant Guideline for Atrial Fibrillation Improves Outcomes in Asian Population: The COOL-AF

Rungroj Krittayaphong1, Arjbordin Winijkul1, Rapeephon Kunjara-Na-Ayudhya2

  • 1From the Division of Cardiology, Siriraj Hospital (R.K.,A.W.), Mahidol University, Bangkok, Thailand.

Stroke
|May 12, 2020
PubMed

Insights

Guideline adherence in oral anticoagulant (OAC) management for nonvalvular atrial fibrillation patients in Thailand improves outcomes. Undertreatment or overtreatment increases risks of stroke, bleeding, and death compared to guideline-adherent care.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Oral anticoagulant (OAC) management in nonvalvular atrial fibrillation (NVAF) is crucial for improving patient outcomes.
  • Limited data exist on guideline adherence for OAC in Asian populations, particularly in Thailand.

Purpose of the Study:

  • To investigate clinical outcomes in Thai NVAF patients based on adherence to OAC management guidelines.
  • To compare outcomes between guideline-adherent, undertreated, and overtreated OAC patient groups.

Main Methods:

  • Prospective enrollment of 3327 NVAF patients from 27 hospitals in Thailand, contributing to the COOL-AF Registry.
  • Categorization into guideline adherence, undertreatment (OAC withheld in high/intermediate risk), and overtreatment (OAC in low risk or combined with antiplatelets without indication) groups.
  • Analysis of ischemic stroke, major bleeding, all bleeding, and death rates across the defined patient groups.

Main Results:

  • Guideline adherence was observed in 68.1% of patients (n=2267), undertreatment in 18.8% (n=624), and overtreatment in 13.1% (n=436).
  • Undertreated patients showed significantly higher risks of ischemic stroke and death compared to guideline-adherent patients.
  • Overtreated patients experienced increased risks of bleeding and death relative to guideline-managed patients.

Conclusions:

  • Adherence to OAC management guidelines is associated with improved clinical outcomes in Asian NVAF patients.
  • Both OAC undertreatment and overtreatment in NVAF are linked to increased adverse events compared to guideline-adherent management.

Keywords:
anticoagulantsatrial fibrillationhemorrhagehypertensionthromboembolism

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