Clinical Aspects in Real – Life Patients with Atrial Fibrillation and Different Oral Anticoagulants

Baiba Lurina, Zane Straume, Rudolfs Roze, Davis Polins, Inese Laizane, Janis Raibarts, Linda Ivanova, Kristaps Jurjans, Aivars Lejnieks, Oskars Kalejs
Latvian Centre of Cardiology, Riga Stradins University, P.Stradins University Hospital, Latvia

Background: Oral anticoagulants (OAC) have been first line medication for prevention of thromboembolic events by patients (pts) with non-valvular atrial fibrillation (NVAF) for a long time, although the usage of vitamin K antagonists (VKA) causes many problems.

Methods: The study enrolled 3542 pts with NVAF under OAC therapy in different Latvian hospitals and ambulatory praxis. Bleeding were defined as Clinical Relevant Major Bleeding (CRMB) and Clinical Relevant Non-major Bleeding (CRNMB) according to international guidelines. Second group included 466 physicians.

Results: There were 2214 (62.5%) users of VKA and 1328 (37.5%) users of NOAC. CHA2DS2-VASc in VKA group was 3.4±1.8, in NOAC group it was 2.5±1.5. Bleeding: 31% in VKA vs 3.3% in NOAC users (p<0.001); CRMB in VKA gr.had 52 pts (2.3%) vs 3 (0.2%) CRMB were observed in NOAC (702 dabigatran and 626 rivaroxaban). CRNMB in VKA group had 194 pts (8.76%) vs 21 (1.6%) in NOAC (p<0.01). No significant difference between dabigatran 150 mg and Rivaroxaban 20 mg, 1 CRNMB in dabigatran 110 mg. More than 50% of the VKA users had difficulties to adjust OAC dose and to keep the INR between 2.0 and 3.0. NOAC’s were preferred in pts in electrical cardioversion group 64.7% vs. 35.3% VKA.

Physicians:13.9% cardiologists, 20.8% internal specialities, 23.8% general practitioners, 8.9% surgeons and others, 32.7% resident physicians. – 48.5% did use NOAC in their practice. The main problems for VKA usage are lack of compliance, poor INR control and difficulties in dose adjustment. 82% of doctors did explain interaction of active substances with OAC to their patients.

Conclusions: Clinical usage of OAC for AF patients is more complicated in VKA group due to side effects, complexity of use and drug-drug interaction. NOAC are more safety and have significantly less complications and bleeding rate. In electrical cardioversion group NOAC are preferable for use before and after procedure. Physicians find the usage of NOAC less problematic and they would be ready to use NOAC more often.