'Real-world' antithrombotic treatment in atrial fibrillation: The EURObservational Research Programme Atrial Fibrillation General Pilot survey

BACKGROUND: Current guidelines strongly recommend that oral anticoagulation can be offered to patients with atrial fibrillation and ≥1 stroke risk factors. Also, the guidelines recommend that oral anticoagulation should still be used in the presence of stroke risk factors irrespective of rate or rhythm control METHODS AND RESULTS: In an analysis from the dataset of the Euro Observational Research Programme on Atrial Fibrillation (EORP-AF) Pilot survey (n=3119), we examined antithrombotic therapy prescribing, with particular focus on the risk factors determining oral anticoagulation or antiplatelet therapy use. Where oral anticoagulation was used amongst admitted patients in whom no pharmacological cardioversion, electrical cardioversion or catheter ablation was performed or planned, the majority were prescribed Vitamin K Antagonist therapy (72.2%) whilst novel oral anticoagulants were used on the minority (7.7%). There were no significant difference in bleeding risk factors between the patients treated on the different types of antithrombotic therapies, except for chronic kidney disease, where oral anticoagulation was less commonly used (p=0.0318). Antiplatelet therapy was more commonly used in patients with high HAS-BLED score (≥2) (p<0.0001). Higher oral anticoagulation use was associated with female gender(p=0.0245). Less novel oral anticoagulants use was associated with valvular heart disease (p<0.0001), chronic heart failure(p=0.0010), coronary artery disease(p<0.0001) and peripheral artery disease (p=0.0092). Coronary artery disease was the strongest reason for combination therapy with oral anticoagulation plus antiplatelet drug (OR 8.54, p<0.0001). When the CHA2DS2-VASc score was used, 95.6% with a score of ≥1 received antithrombotic therapy, with 80.5% with a score of ≥1 receiving oral anticoagulation. Of note, 83.7% of those with a score ≥2 received Antithrombotic Therapy; of the latter, 70.9% of those with a score ≥2 received oral anticoagulation. Of the latter, Vitamin K Antagonists were used in 64.1% and novel oral anticoagulants in 6.9%.

CONCLUSION: The EORP-AF Pilot survey provides contemporary data on oral anticoagulation prescribing by European cardiologists for atrial fibrillation. Whilst the uptake of oral anticoagulation (mostly Vitamin K Antagonist therapy) has improved since the EuroHeart survey a decade ago, antiplatelet therapy is still commonly prescribed, with or without oral anticoagulation, whilst elderly patients are commonly undertreated with oral anticoagulation.