Piotr Lodziński1, Monika Gawałko2, Monika Budnik1, Agata Tymińska1, Krzysztof Ozierański1, Marcin Grabowski1, Agnieszka Janion-Sadowska3, Grzegorz Opolski1, Radosław Lenarczyk3, Zbigniew Kalarus4, Gregory Y H Lip5, Paweł Balsam1. 1. 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland 2. 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. mongawalko@gmail.com 3. 2nd Department of Cardiology, Świętokrzyskie Cardiology Center, Kielce, Poland 4. Department of Cardiology, DMS in Zabrze, Medical University of Silesia, Katowice, Poland 5. Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
Abstract
INTRODUCTION: Data on antithrombotic treatment among patients with atrial fibrillation (AF) in Poland are limited. OBJECTIVES: We aimed to describe antithrombotic management within the Polish part of the EUROobservational Research Programme on Atrial Fibrillation General Long-Term Registry. PATIENTS AND METHODS: We analyzed data collected at baseline and at 1‑year follow‑up from 701 Polish patients treated at 25 Polish centers between 2013 and 2016. RESULTS: Any antithrombotic therapy was administered to 94% of patients (vitamin K antagonists [VKAs], 53%; non‑VKA oral anticoagulants [NOACs], 36%; antiplatelet therapy [APT], 4.8%). However, 78% of patients considered as "low‑risk" (CHA2DS2‑VASc = 0 in men or 1 in women) were prescribed oral anticoagulants and 12% were on APT. Independent predictors of NOAC and VKA use were first‑detected AF and device therapy. Predictors of VKA use were lone AF, history of ischemic stroke, and pulmonary embolism or deep vein thrombosis; of NOAC use, permanent AF; of APT use, history of hemorrhagic events and first‑detected or persistent AF; and of no antithrombotic treatment, young age. Incorrect NOAC prescription was more common in the reduced‑dose group than in the full‑dose group (30% vs 7%). During follow‑up, the all‑cause mortality rate was 5.2%, 0.8%, 15%, and 7% (P <0.0001) and the risk of thromboembolic events was 0.4%, 0.5%, 6.2%, and 0% (P = 0.04) in patients on VKA, NOAC, APT, and no treatment, respectively. CONCLUSIONS: Patients with the lowest stroke risk are often overtreated. The choice of proper antithrombotic strategy does not depend solely on factors incorporated in the CHA2DS2‑VASc score. Higher mortality is observed among APT‑treated patients and those without antithrombotic treatment.
INTRODUCTION: Data on antithrombotic treatment among patients with atrial fibrillation (AF) in Poland are limited. OBJECTIVES: We aimed to describe antithrombotic management within the Polish part of the EUROobservational Research Programme on Atrial Fibrillation General Long-Term Registry. PATIENTS AND METHODS: We analyzed data collected at baseline and at 1‑year follow‑up from 701 Polish patients treated at 25 Polish centers between 2013 and 2016. RESULTS: Any antithrombotic therapy was administered to 94% of patients (vitamin K antagonists [VKAs], 53%; non‑VKA oral anticoagulants [NOACs], 36%; antiplatelet therapy [APT], 4.8%). However, 78% of patients considered as "low‑risk" (CHA2DS2‑VASc = 0 in men or 1 in women) were prescribed oral anticoagulants and 12% were on APT. Independent predictors of NOAC and VKA use were first‑detected AF and device therapy. Predictors of VKA use were lone AF, history of ischemic stroke, and pulmonary embolism or deep vein thrombosis; of NOAC use, permanent AF; of APT use, history of hemorrhagic events and first‑detected or persistent AF; and of no antithrombotic treatment, young age. Incorrect NOAC prescription was more common in the reduced‑dose group than in the full‑dose group (30% vs 7%). During follow‑up, the all‑cause mortality rate was 5.2%, 0.8%, 15%, and 7% (P <0.0001) and the risk of thromboembolic events was 0.4%, 0.5%, 6.2%, and 0% (P = 0.04) in patients on VKA, NOAC, APT, and no treatment, respectively. CONCLUSIONS:Patients with the lowest stroke risk are often overtreated. The choice of proper antithrombotic strategy does not depend solely on factors incorporated in the CHA2DS2‑VASc score. Higher mortality is observed among APT‑treated patients and those without antithrombotic treatment.