Secondary prevention of thromboembolic complications in patients with nonvalvular atrial fibrillation-clinical practice in relation to guidelines

Introduction: Atrial fibrillation (AF) patients after past thromboembolic complications are at high risk of such subsequent complications and should undergo anticoagulant therapy. Aim of the research: To assess recommended anticoagulant prophylaxis in AF patients after past thromboembolic complica-tions, and an attempt to identify predictors of oral anticoagulant (OAC) use and non-use among these patients. Material and methods: The presented research is a retrospective, unicentric study comprising 1266 AF patients with throm-boembolic complications and CHA2DS2-VASc score & GE; 2, subsequently hospitalized from January 2004 to December 2019 in the referential cardiology centre. Results: In the group of 1266 patients, 1072 of them (84.7%) received OACs, 134 (10.6%) antiplatelet drugs, 36 (2.8%) low mo-lecular weight heparin, and 24 (1.9%) remained without anticoagulant prophylaxis. Between 2004 and 2019 OAC application increased from 70.5% to 95.3% and antiplatelet pharmaceutical use decreased from 23.7% to 1.9%. Independent predictors of OAC use were female sex (OR = 1.57; 95% CI: 1.14-2.17; p = 0.006) and peripheral artery disease (PAD) (OR = 2.59; 95% Cl: 1.48-4.51; p = 0.001). Factors determining no OAC use were age > 74 years (OR = 0.64; 95% CI: 0.46-0.89; p = 0.007) and acute coronary syndrome (ACS) hospitalization or planned coronarography or percutaneous coronary intervention (PCI) (OR = 0.41; 95% CI: 0.28-0.61; p < 0.001). Between 2004 and 2019 an increase in the number of high-risk thromboembolic patients treated with OACs was observed. Conclusions: Independent predictors of OAC use were sex and PAD. The factors that reduced the chance of OAC use were age > 74 years, ACS hospitalization, or planned coronarography or PCI.