Predictors for the Use of New Direct Anticoagulants in Atrial Fibrillation and Their One-Year Adherence

Yanina Castillo Costa, Víctor Mauro, Agostina Barsotti, Luisa Hsu, Adrián Charask, Enrique Fairman, Flavio Delfino, Nicolás Aquino, Alessis Rafaelli, Carlos Barrero

Abstract


Background: Men with CHA2DS2-Vasc score ≥1 or women with CHA2DS2-Vasc score ≥2 and atrial fibrillation/flutter have highindication of antithrombotic treatment.Objective: The aim of this study was to analyze the prevalence of anticoagulant therapy in this population, to find predictorsfor the use of new oral anticoagulants and to analyze the one-year adherence to treatment.Methods: A total of 484 consecutive patients were included in the study. Exclusion criteria were in-hospital mortality (n=12) andCHA2DS2-Vasc score of 0 in both genders and 1 in women (n=67). Finally, 405 patients were analyzed with median age of 76years, 46% women, 76% hypertensive, 25% diabetic, 10% with previous stroke and 30% with history of atrial fibrillation/flutter.Results: A rhythm control strategy was used in 66% of cases and 293 patients were anticoagulated at discharge (72%). Amonganticoagulated patients, 63.5% received new oral anticoagulants, especially those who were younger (74 vs. 79.5 years, p=0.001),with lower history of stroke (5.8% vs.18%, p<0.001), lower median CHA2DS2-Vasc (3 vs.4, p<0.01) and HAS-BLED (1 vs. 2,p<0.01) scores and with sinus rhythm at discharge (73.8% vs. 54.7%, p<0.001). Among 165 patients discharged with new oralanticoagulants and followed up for one year, 55.7% adhered to the indicated new oral anticoagulant, 29.69% had discontinuedthe anticoagulation treatment and 14.5% had switched to acenocoumarol.Conclusions: The study shows that only 70 of patients are anticoagulated at discharge. New oral anticoagulants were usedin more than half of cases, especially in patients at lower clinical risk. At one-year follow-up, 6 out of every 10 patients withindication of new oral anticoagulants at discharge continue this treatment, 1 switches to acenocoumarol and 3 abandonanticoagulant therapy.

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