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  • The aim of this cross sectional

    2019-06-11

    The aim of this cross-sectional study was to investigate the relationships between patient characteristics and antithrombotic therapy prescribed for the prevention of ischemic stroke and systemic embolism in patients with NVAF in clinical practice. Additionally, because the data were to be used to compare with the characteristic data of postmarketing surveillance (PMS) for dabigatran by Nippon Boehringer Ingelheim [13], which was performed in parallel to this study, patients prescribed with dabigatran were excluded from this study.
    Material and methods
    Results
    Discussion The patient characteristics, CHADS2, and comorbidity in the current study population were similar to those in other Japanese reports [4,15], suggesting that the sample well reflected the Japanese AF population. We investigated the differences in characteristics, CHADS2, and comorbidity among patients prescribed the AP, AC, and AP+AC regimens, to identify the factors determining the choice of regimen. Antithrombotic treatment for patients with NVAF is generally based on anticoagulant preparations, especially warfarin. In this study, there were significant differences in sex, age, smoking history, prevalence e3 ligases of AF, type of AF, CHADS2 scores, and most comorbidities among the three regimens. Specifically, the proportion of male patients, age, and the prevalence periods of AF were higher in the AP+AC group than in the AC group in multiple analysis. Additionally, the prevalence periods of AF and the ratio of permanent/paroxysmal AF types were higher in the AP+AF group than in the AP group. In contrast, there were no differences between the two monotherapy groups. These results suggest that patient characteristics are not the factors for selecting AP or AC monotherapy, but are the factors for adding a combination drug. The average and the classification of the CHADS2 scores are also significant among the three groups. In the AP+AC group, the CHADS2 score was higher than that in the AP group or the AC group; nevertheless, there were no differences between the AP group and the AC group. The comorbidity of cardiovascular risk factors (heart failure, hypertension, stroke, TIA, systematic thromboembolism, pulmonary thromboembolism, deep vein thrombosis, peripheral artery diseases, angina, and MI) were significant among the three groups. The prevalence rates of heart failure and MI were higher in the AP+AC group than in the AP group, and heart failure, stroke, TIA, peripheral artery diseases, dyslipidemia, angina, and MI were higher in the AP+AC group than in the AC group. On the other hand, AP monotherapy was higher in the treatment of peripheral artery diseases and angina than AC monotherapy. These findings suggest that combination therapy is preferentially adopted in AF complicated by other diseases with thrombotic risk. AP monotherapy was adopted in comorbidities caused by atherosclerosis such as angina. These results show that practitioners prescribe antithrombotic agents in line with the recommendations in the cardiovascular guidelines for stroke, MI, AF, and antithrombotic treatment for cardiovascular diseases [8,9,16,17]. We performed a secondary analysis to investigate the common use of OACs. Warfarin (n=2520) and rivaroxaban (n=308) were administered. There were significant differences in factors such as sex, CHADS2 score, heart failure, hypertension, diabetes, and angina and creatinine clearance. These results show that rivaroxaban is prescribed in AF patients with lower risks rather than warfarin. We stratified all patients with anticoagulant treatment into the N, S, and P groups. These results showed a high proportion of women (43.6%) among the naïve patients compared with those in other reports [7,15], suggesting a recent increase in the incidence of female patients with AF. BMI was higher in the P group than in the N and S groups; however, the clinical relevance of this is unclear. There was no statistical difference among the three groups in the CHADS2 score. With regard to the comorbidity, the prevalence rates of heart failure and angina were lower in the N group than in the P group. Conversely, the prevalence rate of peripheral artery diseases was higher in the N group than in the P or S group. Only bleeding history was higher in the S group than in the other two groups. These findings suggest that the switching of anticoagulant agents was unaffected by patient characteristics, CHADS2 score, and comorbidity, but was influenced by bleeding history.