FACTORS ASSOCIATED WITH NEW ORAL ANTICOAGULANT VERSUS VITAMIN K ANTAGONIST USE IN A CONTEMPORARY, NATIONAL, REAL-WORLD OBSERVATIONAL REGISTRY: INSIGHTS FROM THE STROKE PREVENTION AND RHYTHM INTERVENTIONS IN ATRIAL FIBRILLATION (SPRINT-AF) REGISTRY

Abstract: Introduction: Despite a progress in the management of patients with atrial fibrillation this arrhythmia is one of the major causes of stroke, heart failure, sudden death and cardiovascular morbidity. Oral anticoagulation with vitamin K antagonist or non-vitamin K antagonist markedly reduces stroke and mortality in atrial fibrillation patients. Aim: To estimate the real-life vitamin K antagonist and non-vitamin K antagonist oral anticoagulant treatment in past years in Hungary. Method: Analysis of the National Health Insurance Administation database for atrial fibrillation (BNO: I48) between 2010–2015. We assumed that AF patient would turn to health care provides at least once either as inpatients or outpatients in a 5-year period. The patient was accepted as adherent after 6 months therapy and at least 80% oral anticoagulant prescription. Results: The prevalence of AF in Hungary is 3%. The mortality rate of AF 7%–10% per year. The adherence of the old oral anticoagulant treatment was 55%, but it was 69% among patient treated by “new” oral anticoagulant treatment. However, one third of the patients are not treated by effective old or new oral anticoagulant treatment. Conclusions: We need more effort to improve the effective and high adherence oral anticoagulant therapy in our country. Orv Hetil. 2017; 158(39): 1545–1549.

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Stroke Prevention in Atrial Fibrillation

Circulation ◽

10.1161/circulationaha.120.049768 ◽

2020 ◽

Vol 142 (24) ◽

pp. 2371-2388

Author(s):

Aristeidis H Katsanos ◽

Hooman Kamel ◽

Jeff S. Healey ◽

Robert G. Hart

Keyword(s):

Atrial Fibrillation ◽

Clinical Trials ◽

High Risk ◽

Vitamin K ◽

Stroke Prevention ◽

Oral Anticoagulant ◽

Oral Anticoagulants ◽

Vitamin K Antagonist ◽

Bleeding Complications ◽

Secondary Stroke Prevention

Ischemic strokes related to atrial fibrillation are highly prevalent, presenting with severe neurologic syndromes and associated with high risk of recurrence. Although advances have been made in both primary and secondary stroke prevention for patients with atrial fibrillation, the long-term risks for stroke recurrence and bleeding complications from antithrombotic treatment remain substantial. We summarize the major advances in stroke prevention for patients with atrial fibrillation during the past 30 years and focus on novel diagnostic and treatment approaches currently under investigation in ongoing clinical trials. Non–vitamin K antagonist oral anticoagulants have been proven to be safer and equally effective compared with warfarin in stroke prevention for patients with nonvalvular atrial fibrillation. Non–vitamin K antagonist oral anticoagulants are being investigated for the treatment of patients with atrial fibrillation and rheumatic heart disease, for the treatment of patients with recent embolic stroke of undetermined source and indirect evidence of cardiac embolism, and in the prevention of vascular-mediated cognitive decline in patients with atrial fibrillation. Multiple clinical trials are assessing the optimal timing of non–vitamin K antagonist oral anticoagulant initiation after a recent ischemic stroke and the benefit:harm ratio of non–vitamin K antagonist oral anticoagulant treatment in patients with atrial fibrillation and history of previous intracranial bleeding. Ongoing trials are addressing the usefulness of left atrial appendage occlusion in both primary and secondary stroke prevention for patients with atrial fibrillation, including those with high risk of bleeding. The additive value of prolonged cardiac monitoring for subclinical atrial fibrillation detection through smartphone applications or implantable cardiac devices, together with the optimal medical management of individuals with covert paroxysmal atrial fibrillation, is a topic of intensive research interest. Colchicine treatment and factor XIa inhibition constitute 2 novel pharmacologic approaches that might provide future treatment options in the secondary prevention of cardioembolic stroke attributable to atrial fibrillation.

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Factors associated with non–vitamin K antagonist oral anticoagulants for stroke prevention in patients with new-onset atrial fibrillation: Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II (ORBIT-AF II)

American Heart Journal ◽

10.1016/j.ahj.2017.03.024 ◽

2017 ◽

Vol 189 ◽

pp. 40-47 ◽

Cited By ~ 28

Author(s):

Benjamin A. Steinberg ◽

Peter Shrader ◽

Laine Thomas ◽

Jack Ansell ◽

Gregg C. Fonarow ◽

...

Keyword(s):

Atrial Fibrillation ◽

Vitamin K ◽

Stroke Prevention ◽

Oral Anticoagulants ◽

Vitamin K Antagonist ◽

Factors Associated ◽

Informed Treatment ◽

Onset Atrial Fibrillation ◽

New Onset

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Dabigatran for Stroke Prevention in Nonvalvular Atrial Fibrillation: Answers to Challenging “Real-World” Questions

Thrombosis ◽

10.1155/2012/867121 ◽

2012 ◽

Vol 2012 ◽

pp. 1-10 ◽

Cited By ~ 4

Author(s):

Jorge Ferreira ◽

Daniel Ferreira ◽

Miguel Viana-Baptista ◽

Paulo Bettencourt ◽

Rui Cernadas ◽

...

Keyword(s):

Atrial Fibrillation ◽

Real World ◽

Stroke Prevention ◽

Oral Anticoagulant ◽

Dabigatran Etexilate ◽

Direct Thrombin Inhibitor ◽

Thrombin Inhibitor ◽

Joint Effort ◽

Nonvalvular Atrial Fibrillation ◽

New Oral Anticoagulant

Dabigatran etexilate is a novel, oral, reversible, direct thrombin inhibitor that constitutes a major breakthrough for stroke prevention in patients with nonvalvular atrial fibrillation (AF). Dabigatran was the first new oral anticoagulant approved in Europe and became available in Portugal, for stroke prevention in nonvalvular AF, earlier than in most European countries. This paper is the joint effort of a panel of experts from different specialties and provides information on the use of dabigatran, in anticipation of the challenges that will come with increased usage.

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Oral anticoagulation therapy use in patients with atrial fibrillation after the introduction of non-vitamin K antagonist oral anticoagulants: findings from the French healthcare databases, 2011–2016

BMJ Open ◽

10.1136/bmjopen-2018-026645 ◽

2019 ◽

Vol 9 (4) ◽

pp. e026645 ◽

Cited By ~ 15

Author(s):

Géric Maura ◽

Cécile Billionnet ◽

Jérôme Drouin ◽

Alain Weill ◽

Anke Neumann ◽

...

Keyword(s):

Atrial Fibrillation ◽

Antiplatelet Therapy ◽

Vitamin K ◽

Stroke Prevention ◽

Oral Anticoagulant ◽

Oral Anticoagulants ◽

Anticoagulation Therapy ◽

Vitamin K Antagonist ◽

Secondary Outcome ◽

Patterns Of Use

ObjectivesTo describe (i) the trend in oral anticoagulant (OAC) use following the introduction of non-vitamin K antagonist oral anticoagulant (NOAC) therapy for stroke prevention in atrial fibrillation (AF) patients and (ii) the current patterns of use of NOAC therapy in new users with AF in France.Design(i) Repeated cross-sectional study and (ii) population-based cohort study.SettingFrench national healthcare databases (50 million beneficiaries).Participants(i) Patients with identified AF in 2011, 2013 and 2016 and (ii) patients with AF initiating OAC therapy in 2015–2016.Primary and secondary outcome measures(i) Trend in OAC therapy use in patients with AF and (ii) patterns of use of NOAC therapy in new users with AF.ResultsBetween 2011 and 2016, use of OAC therapy moderately increased (+16%), while use of antiplatelet therapy decreased (−22%) among all patients with identified AF. In 2016, among the 1.1 million AF patients, 66% used OAC therapy and were more likely to be treated by vitamin K antagonist (VKA) than NOAC therapy, including patients at higher risk of stroke (63.5%), while 33% used antiplatelet therapy. Among 192 851 new users of OAC therapy in 2015–2016 with identified AF, NOAC therapy (66.3%) was initiated more frequently than VKA therapy, including in patients at higher risk of stroke (57.8%). Reduced doses were prescribed in 40% of NOAC new users. Several situations of inappropriate use at NOAC initiation were identified, including concomitant use of drugs increasing the risk of bleeding (one in three new users) and potential NOAC underdosing.ConclusionsOAC therapy use in patients with AF remains suboptimal 4 years after the introduction of NOACs for stroke prevention in France and improvement in appropriate prescribing regarding NOAC initiation is needed. However, NOAC therapy is now the preferred drug class for initiation of OAC therapy in patients with AF, including in patients at higher risk of stroke.

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