Oral Anticoagulant Adequacy in Non-Valvular Atrial Fibrillation in Primary Care: A Cross-Sectional Study Using Real-World Data (Fantas-TIC Study)

• Main Authors: M. Rosa Dalmau Llorca, Carina Aguilar Martín, Noèlia Carrasco-Querol, Zojaina Hernández Rojas, Emma Forcadell Drago, Dolores Rodríguez Cumplido, Josep M. Pepió Vilaubí, Elisabet Castro Blanco, Alessandra Q. Gonçalves, José Fernández-Sáez
• Format: Article
• Language: English
• Published: MDPI AG 2021-02-01
• Series: International Journal of Environmental Research and Public Health
• Subjects: atrial fibrillation; direct oral anticoagulants; renal function; time in therapeutic range; vitamin K antagonists
• Online Access: https://www.mdpi.com/1660-4601/18/5/2244

<b>Background:</b> Oral anticoagulants (OAs) are the treatment to prevent stroke in atrial fibrillation (AF). Anticoagulant treatment choice in non-valvular atrial fibrillation (NVAF) must be individualized, taking current guidelines into account. Adequacy of anticoagulant therapy under the current criteria for NVAF in real-world primary care is presented. <strong>Methods:</strong> Cross-sectional study, with real-world data from patients treated in primary care (PC). Data were obtained from the System for the Improvement of Research in Primary Care (SIDIAP) database, covering 60,978 NVAF-anticoagulated patients from 287 PC centers in 2018. <strong>Results</strong>: In total, 41,430 (68%) were treated with vitamin K antagonists (VKAs) and 19,548 (32%) NVAF with direct-acting oral anticoagulants (DOACs). Inadequate prescription was estimated to be 36.0% and 67.6%, respectively. Most DOAC inadequacy (77.3%) was due to it being prescribed as a first-line anticoagulant when there was no history of thromboembolic events or intracranial hemorrhage (ICH). A total of 22.1% had missing estimated glomerular filtration rate (eGFR) values. Common causes of inadequate VKA prescription were poor control of time in therapeutic range (TTR) (98.8%) and ICH (2.2%). <strong>Conclusions:</strong> Poor adequacy to current criteria was observed, being inadequacy higher in DOACs than in VKAs. TTR and GFR should be routinely calculated in electronic health records (EHR) to facilitate decision-making and patient safety.