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SUBANALISIS II CONAREC XIX

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Real world use of Novel Oral Anticoagulants for Atrial Fibrillation in Argentinian Cardiology Training Centers

Ezequiel Zaidel, Juan Alberto Moukarzel, Valentin Roel, Ignacio Cigalini, Daniela Cardillo, Soledad Tejera, Rodolfo Leiva, Jorge Thierer. CONAREC, Consejo Argentino de Residentes de Cardiología. Argentine Council of Cardiology Residents. Argentina.

Background

Embolic events are one of the most serious complications of Atrial Fibrillation (AF). The development of Novel Oral Anticoagulants (NOACs) with a better pharmacokinetic profile and a potential reduction of bleeding and embolic events may modify therapeutics. Prior registries from other countries demonstrated excessive bleeding events in comparison to randomized clinical trials (RCTs) mostly due to inappropriate indications. There is no data about this issue in Argentina.

Aims

To describe the rate of use of NOACs for AF in cardiology training centers in Argentina and compare it with worldwide registries. To compare baseline characteristics of patients (P) that received NOACS with RCTs patients.

Methods

CONAREC XIX is the most recent multicentric registry of AF in Argentina. It was a prospective registry of inpatients admitted for a cardiovascular reason at 59 cardiology training centers, who had AF at admission or in the last 12 months. We compared the rate of use of NOACs with European and American registries. We also compared baseline characteristics of our NOACs patients with those on ROCKET and RELY trials. When the registry was developed Apixaban was not available in Argentina. Conventional descriptive statistics was performed, and the comparison of patients was made with χ2, T test, or Fisher as needed. We used SPSS and Epi Info statistic tools.

Results

992 patients were included. After excluding P who died during hospitalization (57), the rate of use of NOAC was 9,7% (91 patients), vitamin K antagonists (VKA) 50%, and no anticoagulants in 40,1% (Figure 1). We found data from three large multicentric registries (EORP, ORBIT, PREFER), and the rate of use of NOACs was similar to ours (6%, 7,7%, 5%, respectively, vs CONAREC 9,7%) (Figure 2).

When we compared baseline characteristics, we found that NOACs Dabigatran 110, Dabigatran 150, and Rivaroxaban 20, were indicated to younger and healthier P, mainly with Dabigatran 150 (up to 50% of CHAD2S score = 0) (Figure 3), with significantly lower rate of hypertension, stroke, diabetes and heart failure.

We found inappropriate indications of NOACS in patients with valvular AF (4,3%), and also prescription to patients who were not evaluated in clinical trials (Table 1).

Conclusions

In cardiology training centers from Argentina, the rate of use of NOACs for AF is similar to international registries. Real world patients who receive NOACs are younger and have lower embolic risk than patients from clinical trials.

 

 

INTERNATIONAL SOCIETY OF CARDIOLOGY PHARMACOTHERAPEUTICS 2015

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