Yonsei Med J.  2020 Feb;61(2):120-128. 10.3349/ymj.2020.61.2.120.

Current Anticoagulant Usage Patterns and Determinants in Korean Patients with Nonvalvular Atrial Fibrillation

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. cby6908@yuhs.ac
  • 2Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea.
  • 3Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Korea.
  • 4Department of Cardiology, School of Medicine, Ewha Womans University, Seoul, Korea.
  • 5Department of Cardiology, Hanyang University Seoul Hospital, Seoul, Korea.
  • 6Division of Cardiology, Eulji University Hospital, Daejeon, Korea.
  • 7Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea.
  • 8Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea.
  • 9Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
  • 10Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 11Department of Preventive Medicine, Institute of Human Complexity and Systems Science, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
Stroke prevention in patients with atrial fibrillation (AF) is influenced by many factors. Using a contemporary registry, we evaluated variables associated with the use of warfarin or direct oral anticoagulants (OACs).
MATERIALS AND METHODS
In the prospective multicenter CODE-AF registry, 10529 patients with AF were evaluated. Multivariate analyses were performed to identify variables associated with the use of anticoagulants.
RESULTS
The mean age of the patients was 66.9±14.4 years, and 64.9% were men. The mean CHA2DS2-VASc and HAS-BLED scores were 2.6±1.7 and 1.8±1.1, respectively. In patients with high stroke risk (CHA2DS2-VASc ≥2), OACs were used in 83.2%, including direct OAC in 68.8%. The most important factors for non-OAC treatment were end-stage renal disease [odds ratio (OR) 0.27; 95% confidence interval (CI): 0.19-0.40], myocardial infarct (OR 0.53; 95% CI: 0.40-0.72), and major bleeding (OR 0.57; 95% CI: 0.39-0.84). Female sex (OR 1.40; 95% CI: 1.21-1.61), cancer (OR 1.78; 95% CI: 1.38-2.29), and smoking (OR 1.60; 95% CI: 1.15-2.24) were factors favoring direct OAC use over warfarin. Among patients receiving OACs, the rate of combined antiplatelet agents was 7.8%. However, 73.6% of patients did not have any indication for a combination of antiplatelet agents.
CONCLUSION
Renal disease and history of valvular heart disease were associated with warfarin use, while cancer and smoking status were associated with direct OAC use in high stroke risk patients. The combination of antiplatelet agents with OAC was prescribed in 73.6% of patients without definite indications recommended by guidelines.

Keyword

Atrial fibrillation; anticoagulation; pattern; determinant
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