학술논문
Demographic, clinical, and functional determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation
Document Type
Report
Author
Mostaza, Jose María; Suarez, Carmen; Cepeda, Jose María; Manzano, Luis; Sánchez, Demetrio; Lora, Fernando Javier Sánchez; Ibaéez Bermúdez, Francisco; Jurado Porcel, Ana María; Salgado Ordoéez, Fernando; Rivera Civico, Francisco; Díez García, Luis Felipe; Jaén Ãguila, Fernando; Geraldía Lama, Manuel; Peral Gutiérrez-Ceballos, Enrique; Domínguez, Antonia; Astudillo Martín, Francisco; Aguilar, Eduardo; Ferrando Vela, Juan; García Aranda, Alfonso; Sánchez Cembellín, Mercedes; López Caleya, Juan Francisco; Ruiz, Sixto; Rodríguez Gaspar, Melchor; Conde Martel, Alicia; Hernández Hernández, José Luis; Abascal Carrera, Ismael; Pérez del Molino Castellanos, Alfonso; Fernández Pérez, Esther; Martínez Acitores, Juan Carlos; Cortes, Luis Miguel Seisdedos; Abad Manteca, Laura; Budiéo Sánchez, Marco; Moreno Palomares, José Javier; Coca Prieto, Inmaculada; Muéoz, Ana Isabel; Sánchez Castaéo, Ãngel; Ruiz Ribó, Lola; Mascaró, Jordi; Morcillo Serra, César; Auguet Quintillá, Teresa; Marimón, Francesz; Fernández Solá, Joaquín; Suriéach, José María; Marchena, Pablo; Riera-Mestre, Antoni; Armario, Pedro; García Bragado, Ferrán; del Molino, Fátima; Sacristán, Oscar; Almagro, Pere; Falgà, Conxita; Rodríguez, Francisco José Muéoz; Romero Requena, Jorge; Arévalo Lorido, José Carlos; Chiquero Palomo, Manuela; de la Cruz, Ana Isabel; Pijerro, Agustín; Fernández Bouza, Elena; González Soler, Juan José; Núéez Fernández, Manuel Jesús; De La Fuente Aguado, Javier; Díaz Peromingo, José Antonio; Fernández Martín, Julián; Daroca Pérez, Rafael; Castiella Herrero, Jesús; Carreéo, M. Cruz; Gómez Cerezo, Jorge; Pontes Navarro, José Carlos; Varona Arche, José Felipe; Ferreiro López, Daniel; Muéoz Calvo, Benjamín; Casado Cerrada, Jesús Manuel; Fidalgo Montero, María del Pilar; Casas Rojo, José Manuel; Herreros, Benjamín; Cuevas Tascón, Guillermo; Muiéo Miguez, Antonio; Marrero Francés, Jorge; Ortega, Nicolas; Trujillo, Javier; Sánchez Ãlvarez, Julio; Catalán Ramos, Jose Ignacio; Fresco Benito, Francisco Javier; Anuzita Alegría, Ainhoa; Teruel, Carlos; Artero Mora, Arturo; Moral, Pedro; Seguí Ripoll, José Miguel; Bonilla Rovira, Fernando; Maestre Peiro, Ana
Source
BMC Cardiovascular Disorders. August 9, 2021, Vol. 21 Issue 1
Subject
Language
English
ISSN
1471-2261
Abstract
Author(s): Jose María Mostaza[sup.1] , Carmen Suarez[sup.2] , Jose María Cepeda[sup.3] , Luis Manzano[sup.4] , Demetrio Sánchez[sup.5] , Fernando Javier Sánchez Lora[sup.6] , Francisco Ibaéez Bermúdez[sup.7] , Ana María Jurado [...]
Background This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting. Methods A multicenter, cross-sectional study was conducted in NVAF patients who attended internal medicine departments for either a routine visit (outpatients) or hospitalization (inpatients). Results A total of 961 patients were evaluated. Their antithrombotic management included: no treatment (4.7%), vitamin K antagonists (VKAs) (59.6%), direct oral anticoagulants (DOACs) (21.6%), antiplatelets (6.6%), and antiplatelets plus anticoagulants (7.5%). Permanent NVAF and congestive heart failure were associated with preferential use of oral anticoagulation over antiplatelets, while intermediate-to high-mortality risk according to the PROFUND index was associated with a higher likelihood of using antiplatelet therapy instead of oral anticoagulation. Longer disease duration and institutionalization were identified as determinants of VKA use over DOACs. Female gender, higher education, and having suffered a stroke determined a preferential use of DOACs. Conclusions This real-world study showed that most elderly NVAF patients received oral anticoagulation, mainly VKAs, while DOACs remained underused. Antiplatelets were still offered to a proportion of patients. Longer duration of NVAF and institutionalization were identified as determinants of VKA use over DOACs. A poor prognosis according to the PROFUND index was identified as a factor preventing the use of oral anticoagulation. Keywords: Antithrombotic treatment, Direct-acting oral anticoagulants (DOACs), Nonvalvular atrial fibrillation (NVAF), Vitamin K antagonists (VKAs)
Background This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting. Methods A multicenter, cross-sectional study was conducted in NVAF patients who attended internal medicine departments for either a routine visit (outpatients) or hospitalization (inpatients). Results A total of 961 patients were evaluated. Their antithrombotic management included: no treatment (4.7%), vitamin K antagonists (VKAs) (59.6%), direct oral anticoagulants (DOACs) (21.6%), antiplatelets (6.6%), and antiplatelets plus anticoagulants (7.5%). Permanent NVAF and congestive heart failure were associated with preferential use of oral anticoagulation over antiplatelets, while intermediate-to high-mortality risk according to the PROFUND index was associated with a higher likelihood of using antiplatelet therapy instead of oral anticoagulation. Longer disease duration and institutionalization were identified as determinants of VKA use over DOACs. Female gender, higher education, and having suffered a stroke determined a preferential use of DOACs. Conclusions This real-world study showed that most elderly NVAF patients received oral anticoagulation, mainly VKAs, while DOACs remained underused. Antiplatelets were still offered to a proportion of patients. Longer duration of NVAF and institutionalization were identified as determinants of VKA use over DOACs. A poor prognosis according to the PROFUND index was identified as a factor preventing the use of oral anticoagulation. Keywords: Antithrombotic treatment, Direct-acting oral anticoagulants (DOACs), Nonvalvular atrial fibrillation (NVAF), Vitamin K antagonists (VKAs)