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Clinical pharmacy
CP-123 Non-valvular atrial fibrillation: Effectiveness of vitamin K antagonist vs novel oral anticoagulant treatments
  1. G Rodriguez Torne1,
  2. M Cañadas Garre2,
  3. A Caballero Romero1,
  4. D Blanquez Martinez1,
  5. I Casas Hidalgo1,
  6. J Cabeza Barrera1
  1. 1UGC Intercentros-Interniveles Hospital Universitario San Cecilio, Pharmacy, Granada, Spain
  2. 2UGC Intercentros-Interniveles Hospital Virgen de Las Nieves, Pharmacy, Granada, Spain

Abstract

Background Non-valvular atrial fibrillation (NVAF) is the most common cardiac arrhythmia in clinical practice, affecting nearly 1% of the general population1.

Anticoagulation therapy with vitamin K antagonist (VKA) is a treatment used for prevention of ischaemic stroke associated with NVAF. Novel oral anticoagulants (NOACs) (rivaroxaban, dabigatran, apixaban) do not have limitations related to monitoring of anticoagulation, and have been shown to be at least as effective as VKA.

Purpose To estimate the comorbidities and the incidence rates for stroke in NVAF patients treated with VKA and NOACs.

Material and methods This was an observational, non-interventional retrospective cohort study of adult patients diagnosed with NVAF during the study period (June 2010–June 2013).

Results 5231 patients were included in the study with a diagnosis of NVAF (4940 with VKA and 291 with NOACs), of whom 63% (n = 3306) had permanent AF, 22% (n = 1135) paroxysmal AF and 15% (n = 790) persistent AF.

The gender distribution showed that 49% (n = 2589) were male compared with 51% (n = 2642) female. The proportion of NVAF by age was 4.5% (n = 233) of patients <60 years, 16.5% (n = 861) aged 60–70 years, 47% (n = 2460) 70–80 years and 32.1% (n = 1677) of patients >80 years. The most common comorbidities were hypertension (70%, n = 3698) and congestive heart failure (42%, n = 2201).

Regarding ischaemic strokes rates per 100 patient years, we found 2.73% of all VKA treated patients and 2.05% of all NOACs treated patients suffered an ischaemic stroke. We did not find a significant overall difference between events of stroke and the different oral anticoagulants used (p = 0.244); 86% (n = 148) ischaemic stroke, 12% (n = 21) haemorrhagic and 2% (n = 4) unknown.

Conclusion Comorbidities observed are in line with other studies consulted on NVAF, and like them, this disease increases with age. Rates of stroke or systemic embolism in both cohorts of NVAF did not differ by treatment assignment (VKA vs NOACs, p = 0.244).

References and/or Acknowledgements

  1. Go AS, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention. JAMA 2001;285:2370-5

References and/or AcknowledgementsNo conflict of interest.

https://doi.org/10.1136/ejhpharm-2016-000875.123

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