TORNA ALL’ELENCO

Predictors of use of oral anticoagulants in non valvular atrial fibrillation patients: the ATA-AF survey in European Journal of Internal Medicine

2011
ASL Torino 3

Tipo pubblicazione

Conference Abstract

Autori/Collaboratori (10)Vedi tutti...

Gussoni G
Azienda Ospedaliera Universitaria Policlinico Vittorio Emanuele Ferrarotto, Santa Marta, S. Bambino, Dipartimento di Medicina, Catania, Italy
Panuccio D
Azienda Ospedaliera Universitaria Policlinico Vittorio Emanuele Ferrarotto, Santa Marta, S. Bambino, Dipartimento di Medicina, Catania, Italy
Carvalho P
Azienda Ospedaliera Universitaria Policlinico Vittorio Emanuele Ferrarotto, Santa Marta, S. Bambino, Dipartimento di Medicina, Catania, Italy

et alii...

Abstract

Background: Oral anticoagulation therapy (OAT) offers the best protection against ischemic stroke in atrial fibrillation (AF), but vitamin K antagonists are cumbersome to use and their prescription is far from recommended by guidelines. Aim of the ATA-AF study was to evaluate the predictor of use of OAT in “real world” AF patients. Methods: From May to July 2010, 7148 patients with current or previous diagnosis of AF were prospectively enrolled in 196 Italian Internal Medicine (IM) and 164 Cardiology (C) centres. OAT was analyzed in 4845 patients with non-valvular AF. Thrombotic and hemorrhagic risk were evaluated by means of CHADS2 score and a study-specific bleeding score (HAS-BLED without the item “labile INR”). Results: 63.9% of patients had a CHADS2 score ?2 (IM: 75.3% - C: 53.1%), and 28.4% a bleeding score ?3 (44.0% IM - 19.4% C). OAT was prescribed in 55.5% of the patients (46% IM and 64% C). Age ? 75, female gender, paroxysmal AF, cognitive impairment, CHADS2 <2 and ATA-AF bleeding score ?3 were negative predictors of use of OAT (multivariable analysis). Figure 1 reports prescription rates of OAT according to CHADS2 and ATA-AF bleeding scores. Conclusions: OAT is less frequently used in IM than in C, and general characteristics of IM patients (older, more frequent cognitive impairment, higher bleeding risk) may account for this finding. Choice for OAT frequently depends on the individual patient, and the percentage of patients in whom prescription is independent from scores of thrombotic or hemorrhagic risk is not negligible. (Graph presented).

DOI : 10.1016/S0953-6205(11)60160-X

Keywords

anticoagulant therapy; cognitive defect; risk; prescription; bleeding; atrial fibrillation; human; patient; internal medicine; antivitamin K; anticoagulant agent; protection; brain ischemia; diagnosis; cardiology; gender; international normalized ratio; female;