Vitamin K and non-vitamin K antagonist oral anticoagulants for non-valvular atrial fibrillation in real-life

• The patterns of “real world” usage of NOACs-patients were compared to VKAs-patients.
• NOAC agents were used in higher risk patients both for stroke and bleeding.
• Reduced dose of NOACs were prescribed in a large percentage of patients.

BackgroundCurrent guidelines recommend vitamin K antagonists (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in patients with non-valvular atrial fibrillation (AF).MethodsWe compared the clinical features of consecutive in- and out-patients with non-valvular AF newly-treated with NOACs or on treatment with VKAs.ResultsOverall, 1314 patients newly-treated with NOACs and 1024 on treatment with VKAs were included in the study. The mean CHA2DS2-VASc score was 4.3 ± 1.5 and 4.0 ± 1.5 and the mean HAS-BLED score was 2.8 ± 1.2 and 2.2 ± 1.1 in the two groups, respectively (both p < 0.001). Hypertension, previous stroke, female gender, vascular diseases and previous bleeding were more prevalent in NOACs patients. Renal failure, age ≥ 75 years and congestive heart failure were more prevalent in VKAs patients. Among NOACs patients, 438 were given dabigatran, 463 rivaroxaban and 413 apixaban (33%, 35% and 31%, respectively). The mean CHA2DS2-VASc and HAS-BLED scores were higher in rivaroxaban or apixaban patients compared with dabigatran (both p < 0.001) and VKAs patients (both p < 0.001). A lower mean age was observed in patients newly-treated with dabigatran. Patients newly-treated with reduced doses of NOACs (599 patients, 45.5%) had a higher CHA2DS2-VASc (4.8 ± 1.4 vs. 3.9 ± 1.5 vs. 4.0 ± 1.5) and HAS-BLED (2.9 ± 1.1 vs. 2.8 ± 1.2 vs. 2.2 ± 1.1) scores compared with those treated with regular doses of NOACs or VKAs.ConclusionPatients given rivaroxaban and apixaban in clinical practice have a higher thrombotic and hemorrhagic risk in comparison with patients given dabigatran or VKAs. A considerable proportion of patients receive reduced doses of NOACs.