Trends in prescribing anticoagulation therapy for patients with atrial fibrillation among Warsaw population. Do the up-to-date guidelines influence the choice of treatment?

Abstract:
The most relevant complications of atrial fibrillation (AF) are thromboembolic events. Probability of the above could be reduced with an anticoagulant therapy. Since 1954, a group of vitamin K antagonists (VKA) has been administered including warfarin and acenocoumarol. In 2011 novel oral anticoagulants (NOAC) like dabigatran, rivaroxaban and apixaban were introduced. The purpose of this study was to analyse the type of anticoagulant therapy used among patients with AF. It was a cross-sectional survey study which included 268 randomly selected patients treated in inpatient and out-patient cardiac clinics in the left-bank Warsaw district. The study inclusion criteria were confirmed nonvalvular atrium fibrillation (NVAF) and the use of anticoagulant therapy. 36% of patients from the study group received VKA (60 acenocoumarol, 36 warfarin), 51% NOAC (90 rivaroxaban, 47 dabigatran), 13% were treated with acetylsalicylic acid, low molecular weight heparin or clopidogrel. Especially worthy of note is the fact that 90% of patients treated with VKA have not received a proposition of treatment with NOAC from their attending physician. 13% of patients with VKA treatment refused transferring to a new treatment because of its price. According to the respondents acceptable cost of monthly therapy ranges between 20 PLN and 100 PLN. The tendency of treatment of AF is consistent with up-to-date guidelines. Once a day dosage of rivaroxaban potentially leads to higher compliance and makes it the first choice of NOAC among physicians. The lack of proposition of treatment with NOAC from attending physicians deprives the patients’ opportunity of innovative, consistent with up-to-date guidelines of anticoagulant therapy.

Authors:
Wieslawa B. Duda-Krol, Carlo Bienkowski, Aleksandra Wilk, Zuzanna Zak, Anna Zarek, Agata Kudas, Maria Lukasiewicz, Artur Mamcarz

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