AUTHOR=Calderon Jose Miguel , Martinez Fernando , Diaz Javier , Fernandez Antonio , Sauri Inmaculada , Uso Ruth , Trillo Jose Luis , Vela Sara , Bea Carlos , Redon Josep , Forner Maria Jose 

TITLE=Real-World Data of Anticoagulant Treatment in Non-valvular Atrial Fibrillation

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.733300

DOI=10.3389/fcvm.2021.733300

ISSN=2297-055X

ABSTRACT=Aims: To assess the impact of anticoagulant treatment, on risk for stroke and all-cause mortality of patients with atrial fibrillation, using real world data.
Methods: Patients with prevalent or incident atrial fibrillation were selected throughout a study period of 5 years. Stroke, transitory ischemic attack, haemorrhagic stroke, and all-cause mortality were identified in the claims of the EHR.  Subjects were classified according to the anticoagulant treatment in four groups: untreated, VKA, NOACs and antiplatelet (AP). Risk of each of these events and protection with anticoagulant therapy were calculated by Cox proportional hazard models adjusted by potential confounders.
Results: From a total population of 3799884 patients older than 18, 123227 patients with  incident or prevalent AF were identified (mean age 75.2±11.5 years old; 51.9% females). During an average follow-up of 3.2 years, there were 17113 ischaemic strokes and TIA, 780 haemorrhagic strokes and 42558 all-cause deaths (incidence of 46, 8, 2, and 120 per 1000 patients/year, respectively). 11.7% of patients with a CHA2DS2,VASc Score equal or greater than 2 did not receive any anticoagulant therapy along the study period, and a large proportion of patients, 47% shifted from one treatment to the other. Although all kinds of anticoagulant treatment were significantly protective factors against stroke, transitory ischemic attack, and all-cause mortality, NOAC treatment offered significantly better protection compared to the other groups.
Conclusions: In the real-world, the use of anticoagulant treatments is far from guidelines recommendations and is characterized by variability in their use. NOACs offered better protection compared with VKAs.