Effects of the availability of new oral anticoagulants in patients with non-valvular atrial fibrillation in the real world: the NAIF study

Guidelines recommend anticoagulation to prevent stroke in patients with non-valvular atrial fibrillation (NVAF). In the real world, this treatment is underused, probably for pharmacologic limitations of vitamin-K-antagonist (VKA). The new oral anticoagulants (NOAC) overcome many limitations of VKA. The aim of this study is to assess if, after introduction of NOAC, anticoagulated patients are increased. We performed an observational retrospective cohort study about patients with NVAF, hospitalized in Internal Medicine or Geriatrics for any cause in two years, before and after the marketing of NOAC. The results showed: 640 patients enrolled (289 in 2012, 351 in 2015), elderly population (83±7), males 42% females 58%, high morbidity, high thromboembolic (CHA₂DS₂VASc 5±1.6) and hemorrhagic (HASBLED 2.7±1.2) risks, with frequent chronic renal disease (51% stage ‰¥3) and contraindications to anticoagulants (21.6%). Therapy at discharge 2012 vs 2015: VKA 124/289 (43%) vs VKA or NOAC 187/351 (53%) (P<0.01); antiplatelet 114/289 (39%) vs 70/351 (20%) (P<0.0001). For the high comorbidity, frequent use of low-molecular-weight heparin: 42/289 (15%) in 2012 vs 77/351 (22%) in 2015. NOAC have increased the adherence to guidelines in prescribing oral anti-coagulants in patients with NVAF.