Control Of Anticoagulation Therapy in Atrial Fibrillation (COAT-AF Study) in Real Clinical Practice

Aim. To study the frequency of prescribing anticoagulant therapy in outpatients with AF in accordance with clinical guidelines.

Material and methods. Control Of Anticoagulation Therapy in Atrial Fibrillation (COAT-AF) observational study was conducted at the Saint Joasaph Belgorod Regional Clinical Hospital from January 1, 2016 to December 31, 2017. Patients with AF represented 15.5% of all patients admitted to cardiology department N1. 429 patients were included into the study: 203 women, 226 men; aged of 62.55±11.12 years. Exclusion criteria were mitral stenosis, mechanic prosthetic valve, first episode of AF. CHA2DS2-VASc score was used in all patients for calculation the risk of ischemic stroke and systemic thromboembolism. For patients that were treated by warfarin international normalization ratio (INR) was assessed at admission and discharge from the hospital.

Results. From 429 patients 35 had 1 point according to the CHA2DS2-VASc scale, 393 (91.6%) patients had ≥2 points. Only 1 patient had 0 point. Therefore, most patients had absolute indications to anticoagulant therapy. At admission 60 (14%) patients received new oral anticoagulants (NOACs), 213 (49.6%) – warfarin, 156 (36.4%) – did not take any oral anticoagulant. Among patients receiving warfarin only 36 (8.4%) had target INR at admission. Therefore, effective anticoagulant therapy was observed only in 22.4% of patients in real clinical practice. Analyzing anticoagulant therapy in 2016 and 2017 we found a significant increase in NOAC prescription from 10.4% in 2016 to 18.9% in 2017 (p=0.0193).

Conclusion. Our data reflects important gaps of anticoagulant therapy in real clinical practice. We compare our results with other Russian registries that included AF-patients. Data at admission and discharge suggests that there are great possibilities for optimization of anticoagulant therapy mainly with NOACs.

1. Kirchhof P., Benussi S., Kotecha D., et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893-962. DOI:10.1093/eurheartj/ehw210.

2. Shazly A., Afifi A. RE-ALIGN: First trial of novel oral anticoagulant in patients with mechanical heart valves – The search continues. Glob Cardiol Sci Pract. 2014;2014(1):88-9. DOI:10.5339/gcsp.2014.

3. Sulimov V.A., Napalkov D.A., Sokolova A.A. Comparative efficacy and safety of new oral anticoagulants. Rational Pharmacotherapy in Cardiology. 2013;9(4):433-8. (In Russ.) DOI:10.20996/1819-6446-2013-9-4-433-438.

4. Patel M.R., Mahaffey K.W., Garg J., et al., ROCKET-AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365:883-91. DOI:10.1056/NEJMoa1009638.

5. Granger C.B., Alexander J.H., McMurray J.J., et al., ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patient with atrial fibrillation. N Engl J Med. 2011;365:981-92. DOI:10.1056/NEJMoa1107039.

6. Connolly S.J., Connolly S.J., Ezekowitz M.D., et al.; RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139-51. DOI:10.1056/NEJMoa0905561.

7. Boytsov S.A., Loukyanov M.M., Yakushin S.S., et al. Cardiovascular diseases registry (RECVAZA): diagnostics, concomitant cardiovascular pathology, comorbidities and treatment in the real outpatientpolyclinic practice. Cardiovascular Therapy and Prevention. 2014;13(6):44-50 (In Russ.) DOI:10.15829/1728-8800-2014-6-3-8.

8. Martsevich S.Y., Navasardian A.R., Kutishenko N.P., et al. The evaluation of antithrombotic treatment prescription dynamics in patients with atrial fibrillation by the data of PROFILE registry. Cardiovascular Therapy and Prevention. 2015;14(1):35-40 (In Russ.) DOI:10.15829/1728-8800-2015-1-35-40.

9. Polshakova I.L., Povetkin S.V. The register of patients with atrial fibrillation in Kursk region (RECURAF): design and research strategy. Kurskii nauchno-prakticheskii vestnik “Chelovek i ego zdorov’e”. 2017;(4):19-22 (In Russ.)

10. Polshakova I.L., Povetkin S.V. Drug Therapy Structure and Clinical Characteristics of Patients with Atrial Fibrillation According to Data of REKUR-AF Study. Rational Pharmacotherapy in Cardiology. 2018;14(5):733-40 (In Russ.) DOI:10.20996/1819-6446-2018-14-5-733-740.

11. Korennova O.Y., Maltsev S.N., Petrenko A.V., Bulakhova E.Y. Atrial Fibrillationin Clinical Practice: Lessons from a Regional Register. Difficult Patient. 2015;(4):8-10 (In Russ.)