Secondary prevention of thromboembolic complications in patients with nonvalvular atrial fibrillation – clinical practice in relation to guidelines

Introduction
Atrial fibrillation (AF) patients after past thromboembolic complications are at high risk of such subsequent complications and should undergo anticoagulant therapy.

Aim of the research
To assess recommended anticoagulant prophylaxis in AF patients after past thromboembolic complications, and an attempt to identify predictors of oral anticoagulant (OAC) use and non-use among these patients.

Material and methods
The presented research is a retrospective, unicentric study comprising 1266 AF patients with thromboembolic complications and CHA2DS2-VASc score ≥ 2, subsequently hospitalized from January 2004 to December 2019 in the referential cardiology centre.

Results
In the group of 1266 patients, 1072 of them (84.7%) received OACs, 134 (10.6%) antiplatelet drugs, 36 (2.8%) low molecular weight heparin, and 24 (1.9%) remained without anticoagulant prophylaxis. Between 2004 and 2019 OAC application increased from 70.5% to 95.3% and antiplatelet pharmaceutical use decreased from 23.7% to 1.9%. Independent predictors of OAC use were female sex (OR = 1.57; 95% CI: 1.14–2.17; p = 0.006) and peripheral artery disease (PAD) (OR = 2.59; 95% Cl: 1.48–4.51; p = 0.001). Factors determining no OAC use were age > 74 years (OR = 0.64; 95% CI: 0.46–0.89; p = 0.007) and acute coronary syndrome (ACS) hospitalization or planned coronarography or percutaneous coronary intervention (PCI) (OR = 0.41; 95% CI: 0.28–0.61; p < 0.001). Between 2004 and 2019 an increase in the number of high-risk thromboembolic patients treated with OACs was observed.

Conclusions
Independent predictors of OAC use were sex and PAD. The factors that reduced the chance of OAC use were age > 74 years, ACS hospitalization, or planned coronarography or PCI.