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

• Ha HS
• Kim J
• Lee YS
• Kim TH
• Lee JM
• Park J
• Park JK
• Kang KW
• Shim J
• Uhm JS
• Park HW
• Cha MJ
• Choi EK
• Kim J
• Kim JB
• Kim C
• Joung B

• KMID: 2468486
• DOI: http://doi.org/10.3349/ymj.2020.61.2.120

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

MeSH Terms

Anticoagulants
Atrial Fibrillation*
Female
Heart Valve Diseases
Hemorrhage
Humans
Kidney Failure, Chronic
Male
Multivariate Analysis
Myocardial Infarction
Platelet Aggregation Inhibitors
Prospective Studies
Smoke
Smoking
Stroke
Warfarin
Anticoagulants
Platelet Aggregation Inhibitors
Smoke
Warfarin

Figure

• 

  Fig. 1 Method of stroke prevention in patients with AF according to CHA2DS2-VASc score. AF, atrial fibrillation; APT, antiplatelet therapy; DOAC, direct oral anticoagulant.

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  Fig. 2 Method of stroke prevention in patients with AF according to HAS-BLED score. AF, atrial fibrillation; APT, antiplatelet therapy; DOAC, direct oral anticoagulant.

• 

  Fig. 3 Factors favoring OAC or non-OAC treatment in patients with CHA2DS2-VASc ≥2. OAC, oral anticoagulant; BMI, body mass index; MI, myocardial infarct; VHD, valvular heart disease; TIA, transient ischemic attack; ESRD, end-stage renal disease; DM, diabetes mellitus; OR, odds ratio; CI, confidence interval.

• 

  Fig. 4 Factors favoring warfarin or DOAC in patients with CHA2DS2-VASc ≥2. DOAC, direct oral anticoagulant; BMI, body mass index; VHD, valvular heart disease; CKD, chronic kidney disease; ESRD, end-stage renal disease; OR, odds ratio; CI, confidence interval.

• 

  Fig. 5 Factors favoring OAC plus antiplatelet in patients with CHA2DS2-VASc ≥2. OAC, oral anticoagulant; MI, myocardial infarct; PAD, peripheral arterial disease; TIA, transient ischemic attack; CKD, chronic kidney disease; HTN, hypertension; DM, diabetes mellitus; OR, odds ratio; CI, confidence interval.

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