Resumen de Oral anticoagulants in the treatment of atrial fibrillation: Experience in a spanish tertiary hospital

Cristóbal Gallego Muñoz, Nieves Guerrero Navarro, Mª V. Manzano Martín

• Introduction: Atrial fibrillation is the main reason for oral anticoagulation in our community. New Oral Anticoagulants (NOAC) overcome the disadvantages of Vitamin K Antagonists (VKA), although there are scarce data on its use in our community. The aim of this study is to provide an overview of the use of NOAC and oral anticoagulation control with VKA in an actual clinical scenario.

  Method: A retrospective cohort analysis was conducted on 267 patients admitted to cardiology over a period of one year, with a diagnosis of atrial fibrillation and anticoagulant treatment at discharge. We assessed the percentage of patients prescribed NOAC and the therapeutic range with VKA. We compared safety and efficacy events during 12-month follow-up among the patients prescribed NOAC, those prescribed VKA with a good therapeutic range and those with a poor therapeutic range.

  Results: The percentage of patients prescribed NOAC was 7.8%. Serial INR measurements found that 69.5% of patients had a poor therapeutic range. A higher prevalence of hospitalization for heart failure was observed for the patients treated with VKA versus NOAC (59% vs 39%, p=0.02). The rate of hospitalization for arrhythmia and syncope was higher in the NOAC group (28% vs 16%, p = 0.007). We found a higher score on the HAS-BLED scale for the patients with a poor therapeutic range. The mean CHADS₂ score and CHA₂DS₂-VASc score were equivalent in the various subgroups.

  Conclusions: For patients with a previous hospitalization in cardiology in a tertiary hospital, and a primary or secondary diagnosis of atrial fibrillation, the therapeutic range with VKA was poor. NOAC were prescribed at a low rate and were mainly directed at patients with less advanced heart disease, with a safety profile comparable to that described in published clinical trials