Prescription of oral anticoagulation for patients with atrial fibrillation and previous hospitalization in a cardiology department. Experience in actual practice in a tertiary hospital

Ó Fabregat-Andrés; A Cubillos-Arango; N Chacón-Hernández; V Montagud; S Morell; L Fácila

doi:10.1016/j.rce.2015.02.020

Prescription of oral anticoagulation for patients with atrial fibrillation and previous hospitalization in a cardiology department. Experience in actual practice in a tertiary hospital

Rev Clin Esp (Barc). 2015 Aug-Sep;215(6):315-9. doi: 10.1016/j.rce.2015.02.020. Epub 2015 Apr 10.

[Article in English, Spanish]

Authors

Ó Fabregat-Andrés¹, A Cubillos-Arango², N Chacón-Hernández², V Montagud², S Morell², L Fácila²

Affiliations

¹ Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Valencia, España; Fundación para la Investigación, Hospital General Universitario de Valencia, Valencia, España. Electronic address: osfabregat@gmail.com.
² Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Valencia, España.

PMID: 25865051
DOI: 10.1016/j.rce.2015.02.020

Abstract

Introduction: Atrial fibrillation is the main reason for oral anticoagulation in our community. New oral anticoagulants (NOACs) overcome the disadvantages of vitamin K antagonists (VKAs), although there are scarce data on its use in our community. The aim of our study was to assess the use of NOACs and anticoagulation control using VKA as measured by the time within the therapeutic range (TTR) in an actual clinical scenario.

Methods: A retrospective cohort analysis was conducted of 816 patients admitted to cardiology over a period of 3 years, with a diagnosis of atrial fibrillation and anticoagulant treatment at discharge. We assessed the percentage of patients prescribed NOACs and the TTR with VKA. We compared safety and efficacy events during the 15-month follow-up among the patients prescribed NOAC, those prescribed VKA with a good TTR and those with a poor TTR.

Results: The percentage of patients prescribed NOAC was 7.6%. Serial INR measurements found that 71.3% of patients had a poor TTR. Although the groups were not comparable, a higher incidence of the combined event was observed in those treated with VKA and a poor TTR compared with those prescribed NOAC (p=.01).

Conclusions: For patients with a previous hospitalization in cardiology in a tertiary hospital and a diagnosis of atrial fibrillation, the rate of NOAC prescription is low, and the TTR with VKA was poor.

Keywords: Anticoagulación oral; Atrial fibrillation; Fibrilación auricular; Hospitalization; Ingreso hospitalario; Novel anticoagulant agents; Nuevos anticoagulantes orales; Oral anticoagulation.