Abstract 19927: Over-Treatment with Oral Anticoagulants of Non Valvular Atrial Fibrillation Patients at Low Risk of Stroke: The ARAPACIS Study
Underuse of oral anticoagulants is quite common in patients with non-valvular Atrial fibrillation (NVAF) at high risk of stroke; less is known on adequacy of treatment in “low-risk” patients (CHA2DS2-VASc score<2). We explored this issue in patients enrolled in the Atrial fibrillation Registry for Ankle-brachial index Prevalence Assessment-Collaborative Italian Study (ARAPACIS).
From October 2010 to October 2012, 2,027 patients entered the study. Three-hundred-sixteen had CHA2DS2-VASc score<2. More than a half of these patients (58%) were enrolled with paroxysmal AF, 14% with persistent, and 28% with permanent NVAF. Permanent NVAF was more prevalent in patients with at least 1 risk factor (31% vs. 15%); paroxysmal NVAF was less prevalent (56% vs. 65%) in patients without any CHA2DS2-VASc stroke risk factor (p<0.03).
Fifty-six percent of patients with at least 1 stroke risk factor (CHA2DS2-VASc score=1) received oral anticoagulants (OAC), with a significant trend for higher use in those with Permanent NVAF (45%). Twenty-five percent did not receive any anti-thrombotic therapy and 19% received antiplatelet agents (APs); in these two groups patients were enrolled with paroxysmal AF in the 76% of the cases.
Among “truly low-risk” patients, i.e. patients without any CHA2DS2-VASc stroke risk factor, we observed that only one-third (33%) did not receive any anti-thrombotic treatment. Oral anticoagulation was used in 54% and APs in 13% of patients with CHA2DS2-VASc score of 0. The choice of treatment was independent of the type of atrial fibrillation.
Overall, antithrombotic therapy seen in NVAF patients with “truly low-risk” for stroke suggests a partial adherence to recommendations, which is consistent with other similar registries which used the CHA2DS2 score. Even using a score that better identifies the “truly low-risk” patients, the study shows an over-treatment with oral anticoagulants of AF patients at low risk of stroke.
Author Disclosures: F. Santilli: None. V. Raparelli: None. M. Proietti: None. G.R. Corazza: None. F. Perticone: None. P. Pignatelli: None. G. Davì: None. F. Violi: None. S. Basili: None.
- © 2014 by American Heart Association, Inc.