ORIGINAL PAPER
Secondary prevention of thromboembolic complications in patients with nonvalvular atrial fibrillation – clinical practice in relation to guidelines
1
1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, Kielce, Poland
2
Collegium Medicum, Jan Kochanowski University, Kielce, Poland
3
Clinic of Internal Medicine, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
Submission date: 2022-08-02
Final revision date: 2023-02-18
Acceptance date: 2023-05-22
Publication date: 2023-06-30
Medical Studies 2023;39(2):159-171
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Atrial fibrillation (AF) patients after past thromboembolic complications are at high risk of such subsequent complications and should undergo anticoagulant therapy.
Aim of the research:
To assess recommended anticoagulant prophylaxis in AF patients after past thromboembolic complications, and an attempt to identify predictors of oral anticoagulant (OAC) use and non-use among these patients.
Material and methods:
The presented research is a retrospective, unicentric study comprising 1266 AF patients with thromboembolic complications and CHA2DS2-VASc score ≥ 2, subsequently hospitalized from January 2004 to December 2019 in the referential cardiology centre.
Results:
In the group of 1266 patients, 1072 of them (84.7%) received OACs, 134 (10.6%) antiplatelet drugs, 36 (2.8%) low molecular weight heparin, and 24 (1.9%) remained without anticoagulant prophylaxis. Between 2004 and 2019 OAC application increased from 70.5% to 95.3% and antiplatelet pharmaceutical use decreased from 23.7% to 1.9%. Independent predictors of OAC use were female sex (OR = 1.57; 95% CI: 1.14–2.17; p = 0.006) and peripheral artery disease (PAD) (OR = 2.59; 95% Cl: 1.48–4.51; p = 0.001). Factors determining no OAC use were age > 74 years (OR = 0.64; 95% CI: 0.46–0.89; p = 0.007) and acute coronary syndrome (ACS) hospitalization or planned coronarography or percutaneous coronary intervention (PCI) (OR = 0.41; 95% CI: 0.28–0.61; p < 0.001). Between 2004 and 2019 an increase in the number of high-risk thromboembolic patients treated with OACs was observed.
Conclusions:
Independent predictors of OAC use were sex and PAD. The factors that reduced the chance of OAC use were age > 74 years, ACS hospitalization, or planned coronarography or PCI.
Atrial fibrillation (AF) patients after past thromboembolic complications are at high risk of such subsequent complications and should undergo anticoagulant therapy.
Aim of the research:
To assess recommended anticoagulant prophylaxis in AF patients after past thromboembolic complications, and an attempt to identify predictors of oral anticoagulant (OAC) use and non-use among these patients.
Material and methods:
The presented research is a retrospective, unicentric study comprising 1266 AF patients with thromboembolic complications and CHA2DS2-VASc score ≥ 2, subsequently hospitalized from January 2004 to December 2019 in the referential cardiology centre.
Results:
In the group of 1266 patients, 1072 of them (84.7%) received OACs, 134 (10.6%) antiplatelet drugs, 36 (2.8%) low molecular weight heparin, and 24 (1.9%) remained without anticoagulant prophylaxis. Between 2004 and 2019 OAC application increased from 70.5% to 95.3% and antiplatelet pharmaceutical use decreased from 23.7% to 1.9%. Independent predictors of OAC use were female sex (OR = 1.57; 95% CI: 1.14–2.17; p = 0.006) and peripheral artery disease (PAD) (OR = 2.59; 95% Cl: 1.48–4.51; p = 0.001). Factors determining no OAC use were age > 74 years (OR = 0.64; 95% CI: 0.46–0.89; p = 0.007) and acute coronary syndrome (ACS) hospitalization or planned coronarography or percutaneous coronary intervention (PCI) (OR = 0.41; 95% CI: 0.28–0.61; p < 0.001). Between 2004 and 2019 an increase in the number of high-risk thromboembolic patients treated with OACs was observed.
Conclusions:
Independent predictors of OAC use were sex and PAD. The factors that reduced the chance of OAC use were age > 74 years, ACS hospitalization, or planned coronarography or PCI.
REFERENCES (42)
1.
Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001; 285: 2370-2375.
2.
Krijthe BP, Kunst A, Benjamin EJ, Lip GYH, Franco OH, Hofman A, Witteman JCM, Stricker BH, Heeringa J. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J 2013; 34: 2746-2751.
3.
Janion-Sadowska A, Turek Ł, Dudek A, Andrychowski J, Sadowski M. Migotanie i trzepotanie przedsionków – aktualny stan wiedzy. Część 1. Studia Medyczne 2021; 37: 151-161.
4.
Turek Ł, Sadowski M, Janion-Sadowska A, Kurzawski J, Domagała S, Janion M. Nawrót arytmii i niepożądane zdarzenia sercowo-naczyniowe w ciągu 12 miesięcy po kardiowersji elektrycznej u pacjentów z migotaniem przedsionków stosujących doustne leki przeciwzakrzepowe. Medical Studies 2022; 38: 273-286.
5.
Cheng TO. Reduced risk for thromboembolism in atrial fibrillation and mitral regurgitation. Am Heart J 1999; 138: 998-999.
6.
Hijazi Z, Lindbäck J, Alexander JH, Hanna M, Held C, Hylek EM, Lopes RD, Oldgren J, Siegbahn A, Ste- wart RAH, White HD, Granger CB, Wallentin L, ARISTOTLE and STABILITY Investigators. ARISTOTLE and STABILITY Investigators. The ABC (age, biomarkers, clinical history) stroke risk score: a biomarker-based risk score for predicting stroke in atrial fibrillation. Eur Heart J 2016; 37: 1582-1590.
7.
Bejot Y, Salem DB, Osseby GV, Couvreur G, Durier J, Marie C, Cottin Y, Moreau T, Giroud M. Epidemiology of ischemic stroke from atrial fibrillation in Dijon, France, from 1985 to 2006. Neurology 2009; 72: 346-353.
8.
Lamassa M, Di Carlo A, Pracucci G, Basile AM, Trefolo- ni G, Vanni P, Spolveri S, Baruffi MC, Landini G, Ghetti A, Wolfe CD, Inzitari D. Characteristics, outcome, and care of stroke associated with atrial fibrillation in Europe: data from a multicenter multinational hospital-based registry (The European Community Stroke Project). Stroke 2001; 32: 392-398.
9.
Kosmala W, Sanders P, Marwick TH. Subclinical myocardial impairment in metabolic diseases. JACC Cardiovasc Imaging 2017; 10: 692-703.
10.
Rankin AJ, Rankin SH. Cardioverting acute atrial fibrillation and the risk of thromboembolism: not all patients are created equal. Clin Med 2017; 17: 419-423.
11.
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Tho- mas GN, Valgimigli, Van Gelder IC, Van Putte BP, Wat- kins CL, ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42: 373-498.
12.
January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland Jr JC, Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM, Yancy CW. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation 2019; 140: e125-e151.
13.
Steinberg BA, Gao H, Shrader P, Pieper K, Thomas L, Camm AH, Ezekowitz MD, Fonarow GC, Gersh BJ, Goldhaber S, Haas S, Hacke W, Kowey PR, Ansell J, Mahaf- fey KW, Naccarelli G, Reiffel JA, Turpie A, Verheugt F, Piccini JP, Kakkar A, Peterson ED, Fox KAA, GARFIELD-AF; ORBIT-AF Investigators. International trends in clinical characteristics and oral anticoagulation treatment for patients with atrial fibrillation: Results from the GARFIELD-AF, ORBIT-AF I, and ORBIT-AF II registries. Am Heart J 2017; 194: 132-140.
14.
Kirchhof P, Ammentorp B, Darius H, De Caterina R, Le Heuzey JY, Schilling RJ, Schmitt J, Zamorano JL. Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events--European Registry in Atrial Fibrillation (PREFER in AF). Europace 2014; 16: 6-14.
15.
Gorczyca I, Michalska A, Chrapek M , Jelonek O, Wałek P, Wożakowska-Kapłon B. Non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation in secondary stroke and systemic embolism prevention. Cardiol J 2021; 28: 896-904.
16.
Steinberg BA, Ballew NG, Greiner MA, Lippmann SJ, Curtis LH, O’Brien EC, Patel MR, Piccini JP. Ischemic and bleeding outcomes in patients with atrial fibrillation and contraindications to oral anticoagulation. JACC Clin Electrophysiol 2019; 5: 1384-1392.
17.
Yasui T, Shioyama W, Oboshi M, Oka T, Fujita M. oral anticoagulants in japanese patients with atrial fibrillation and active cancer. Intern Med 2019; 58: 1845-1849.
18.
Besford M, Leahy TP, Sammon C, Ulvestad M, Carroll R, Mehmud F, Alikhan R, Ramagopalan S. CHA2DS2-VASc and HAS-BLED risk scores and real-world oral anticoagulant prescribing decisions in atrial fibrillation. Future Cardiol 2021; 17: 855-864.
19.
Eikelboom JW, Wallentin L, Connolly SJ, Ezekowitz M, Healey JS, Oldgren J, Yang S, Alings M, Kaatz S, Hohnloser SH, Diener HC, Franzosi MC, Huber K, Reilly P, Varrone J, Yusuf S. Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation: an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial. Circulation 2011; 123: 2363-2372.
20.
Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W, Breithardt G, Halperin JL, Hankey GJ, Piccini JP, Becker RC, Nessel CC, Paolini JF, Berkowitz SD, Fox KAA, Califf RM, ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J 2011; 365: 883-891.
21.
Connolly SJ, Eikelboom J, Joyner C, Diener HC, Hart R, Golitsyn S, Flaker G, Avezum A, Hohnloser SH, Diaz R, Talajic M, Zhu J, Pais P, Budaj A, Parkhomenko A, Jan- sky P, Commerford P, Tan RS, Sim KH, Lewis BL, Van Mieghem W, Lip GYH, Kim JH, Lanas-Zanetti F, Gonzalez- Hermosillo A, Dans AL, Munawar M, O’Donnell M, Lawrence J, Lewis G, Afzal R, Yusuf S, AVERROES Steering Committee and Investigators. Apixaban in patients with atrial fibrillation. N Engl J Med 2011; 364: 806-817.
22.
Lopes RD, Alexander JH, Al-Khatib SM, Ansell J, Diaz R, Easton JD, Gersh BJ, Granger CB, Hanna M, Horowitz J, Hylek EM, McMurray JJV, Verheugt FWA, Wallentin L, ARISTOTLE Investigators. Apixaban for reduction in stroke and other ThromboemboLic events in atrial fibrillation (ARISTOTLE) trial: design and rationale. Am Heart J 2010; 159: 331-339.
23.
Janion-Sadowska A, Turek Ł, Dudek A, Andrychowski J, Sadowski M. Migotanie i trzepotanie przedsionków – aktualny stan wiedzy. Część 2. Medical Studies 2021; 37: 239-249.
24.
Huisman MV, Rothman KJ, Paquette M, Teutsch C, Die- ner HC, Dubner SJ, Halperin JL, Ma CS, Zint K, Elsaesser A, Bartels DB, Lip GYH. The changing landscape for stroke prevent ion in AF: findings from the GLORIA-AF Registry Phase 2. J Am Coll Cardiol 2017; 69: 777-785.
25.
Ho KH, van Hove M, Leng G. Trends in anticoagulant prescribing: a review of local policies in English primary care. BMC Health Serv Res 2020; 20: 279.
26.
Staerk L, Fosbøl EL, Gadsbøll K, Sindet-Pedersen C, Pallisgaard JL, Lamberts M, Lip GYH, Torp-Pedersen C, Gislason GH, Olesen JB. Non-vitamin K antagonist oral anticoagulation usage according to age among patients with atrial fibrillation: temporal trends 2011–2015 in Denmark. Sci Rep 2016; 6: 31477.
27.
Lee JM, Kim TH, Cha MJ, Park J, Park JK, Kang KW, Shim J, Uhm JS, Kim J, Park HW, Lee YS, Choi EK, Kim CS, Joung B, Kim JB. Gender-related differences in management of nonvalvular atrial fibrillation in an Asian population. Korean Circ J 2018; 48: 519-528.
28.
Thompson LE, Maddox TM, Lei L, Grunwald GK, Brad- ley SM, Peterson PN, Masoudi FA, Turchin A, Song Y, Doros G, Davis MB, Daugherty SL. Sex differences in the use of oral anticoagulants for atrial fibrillation: a report from the National Cardiovascular Data Registry (NCDR®) PINNACLE Registry. J Am Heart Assoc 2017; 6: e005801.
29.
Tracz J, Gorczyca-Głowacka I, Wełnicki M, Kołodziej- ska E, Rosołowska A, Mamcarz A, Wożakowska-Kapłon B. Udar niedokrwienny mózgu u kobiet i mężczyzn – rokowanie wewnątrzszpitalne. Medical Studies 2022; 38: 22-30.
30.
Schwertz DW, Penckofer S. Sex differences and the effects of sex hormones on hemostasis and vascular reactivity. Heart Lung 2001; 30: 401-426.
31.
Chang CJ, Chen YT, Liu CS, Lin WY, Lin CL, Lin MC, Kao CH. Atrial fibrillation increases the risk of peripheral arterial with relative complications and mortality: a population-based cohort study. Medicine (Baltimore) 2016; 95: e3002.
32.
Pande RL, Perlstein TS, Beckman JA, Creager MA. Secondary prevention and mortality in peripheral artery disease: National Health and Nutrition Examination Study, 1999 to 2004. Circulation 2011; 124: 17-23.
33.
Lopes RD, Steffel J, Di Fusco M, Keshishian A, Luo X, Li X, Masseria C, Hamilton M, Friend K, Gupta K, Mardekian J, Pan X, Baser O, Jones WS. Effectiveness and safety of anticoagulants in adults with non-valvular atrial fibrillation and concomitant coronary/peripheral artery disease. Am J Med 2018; 131: 1075-1085.
34.
Baker WL, Beyer-Westendorf J , Bunz TJ, Eriksson D, Meinecke AK, Sood NA, Coleman CI. Effectiveness and safety of rivaroxaban and warfarin for prevention of major adverse cardiovascular or limb events in patients with non-valvular atrial fibrillation and type 2 diabetes. Diabetes Obes Metab 2019; 21: 2107-2114.
35.
Coleman CI, Baker WL, Meinecke AK, Eriksson D, Martinez BK, Bunz TJ, Alberts MJ. Effectiveness and safety of rivaroxaban vs. warfarin in patients with non-valvular atrial fibrillation and coronary or peripheral artery disease. Eur Heart J Cardiovasc Pharmacother 2020; 6: 159-166.
36.
Hanon O, Vidal JS, Le Heuzey JY, Kirchhof P, De Cateri- na R, Schmitt J, Laeis P, Mannucci PM, Marcucci M. Oral anticoagulant use in octogenarian European patients with atrial fibrillation: a subanalysis of PREFER in AF. Int J Cardiol 2017; 232: 98-104.
37.
Kato ET, Giugliano RP, Ruff CT, Koretsune Y, Yamashi- ta T, Kiss RG, Nordio F, Murphy SA, Kimura T, Jin J, Lanz H, Mercuri M, Braunwald E, Antman EM. Efficacy and safety of edoxaban in elderly patients with atrial fibrillation in the ENGAGE-TIMI 48 trial. J Am Heart Assoc 2016; 5: e003432.
38.
Eikelboom JW, Wallentin L, Connolly SJ, Ezekowitz M, Healey JS, Oldgren J, Yang S, Alings M, Kaatz S, Hohnloser SH, Diener HC, Franzosi MG, Huber K, Reilly P, Varrone J, Yusuf S. Risk of bleeding with 2 doses of dabigatran compared with warfarin in older and younger patients with atrial fibrillation an analysis of the randomized evaluation of long-term anticoagulant therapy (RE-LY) trial. Circulation 2011; 123: 2363-2372.
39.
Halperin JL, Hankey GJ, Wojdyla DM , Piccini JP, Lokhnygina Y, Patel MR, Breithardt G, Singer DE, Becker RC, Hacke W, Paolini JF, Nessel CC, Mahaffey KW, Califf RM, Fox KAA, ROCKET AF Steering Committee and Investigators. Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the rivaroxaban once daily, oral, direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation (ROCKET AF). Circulation 2014; 130: 138-146.
40.
Verheugt FWA, Ambrosio G, Atar D, Bassand JP, Camm AJ, Costabel JP, Fitzmaurice DA, Illingworth L, Goldhaber SZ, Goto S, Haas S, Jansky P, Kayani G, Stepin- ska J, Turpie AGG, van Eickels M, Kakkar AK, GARFIELD-AF Investigators. Outcomes in newly diagnosed atrial fibrillation and history of acute coronary syndromes: insights from GARFIELD-AF. Am J Med 2019; 132: 1431-1440.
41.
Lopes RD, Hong H, Harskamp RE, Bhatt DL, Mehran R, Cannon CP, Granger CB, Verheugt FWA, Li J, Berg JMT, Sarafoff N, Gibson CM, Alexander JH. Safety and efficacy of antithrombotic strategies in patients with atrial fibrillation undergoing percutaneous coronary intervention: a network meta-analysis of randomized controlled trials. JAMA Cardiol. 2019; 4: 747-755.
42.
Del Brutto VJ, Chaturvedi S, Diener HC, Romano JG, Sacco RL. Antithrombotic therapy to prevent recurrent strokes in ischemic cerebrovascular disease: JACC Scientific Expert Panel. J Am Coll Cardiol 2019; 74: 786-803.
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