Do Patients with Atrial Fibrillation and a History of Ischemic Stroke Overuse Reduced Doses of NOACs?—Results of the Polish Atrial Fibrillation (POL-AF) Registry

• Published in: International journal of environmental research and public health Vol. 19; no. 19; p. 11939
• Main Authors: Szyszkowska, Anna, Kuźma, Łukasz, Wożakowska-Kapłon, Beata, Gorczyca-Głowacka, Iwona, Jelonek, Olga, Uziębło-Życzkowska, Beata, Krzesiński, Paweł, Wójcik, Maciej, Błaszczyk, Robert, Gawałko, Monika, Kapłon-Cieślicka, Agnieszka, Tokarek, Tomasz, Rajtar-Salwa, Renata, Bil, Jacek, Wojewódzki, Michał, Szpotowicz, Anna, Krzciuk, Małgorzata, Bednarski, Janusz, Bakuła, Elwira, Wełnicki, Marcin, Mamcarz, Artur, Tomaszuk-Kazberuk, Anna
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 21.09.2022; MDPI
• Subjects: Administration, Oral; Anticoagulants; Atrial Fibrillation - chemically induced; Atrial Fibrillation - drug therapy; Atrial Fibrillation - epidemiology; Cardiac arrhythmia; Cardiovascular disease; Dabigatran - adverse effects; Dabigatran - therapeutic use; Embolisms; Fibrinolytic Agents - therapeutic use; Heart attacks; Humans; Ischemic Stroke; Kidney diseases; Mortality; Patients; Poland - epidemiology; Population; Prospective Studies; Pyridones; Registries; Rivaroxaban - adverse effects; Stroke; Vein & artery diseases; Poland; atrial fibrillation; reduced dose; ischemic stroke; anticoagulation
• ISSN: 1660-4601; 1661-7827; 1660-4601
• DOI: 10.3390/ijerph191911939

Background: The aim of our study was to assess if patients with AF (atrial fibrillation) and a history of ischemic stroke (IS) excessively receive reduced doses of NOACs (non-vitamin K antagonist oral anticoagulants). Methods: The Polish AF (POL-AF) registry is a prospective, observational, multicenter study, including patients with AF from 10 cardiology hospital centers. In this study we focused on patients with IS in their past. Results: Among 3999 patients enrolled in the POL-AF registry, 479 (12%) had a previous history of IS. Compared to patients without IS history, post-stroke subjects had a higher CHA2DS2-VASc score (median score 7 vs. 4, p < 0.05). Of these subjects, 439 (92%) had anticoagulation therapy, 83 (18.9%) were treated with a vitamin K antagonist (VKA), 135 (30.8%) with rivaroxaban, 112 (25.5%) with dabigatran, and 109 (24.8%) with apixaban. There were a significant number of patients after IS with reduced doses of NOACs (48.9% for rivaroxaban, 45.5% for dabigatran, and 36.7% for apixaban). In many cases, patients were prescribed reduced doses of NOACs without any indication for reduction (28.8% of rivaroxaban use, 56.9% of dabigatran use, and 60.0% of apixaban use—out of reduced dosage groups, p = 0.06). Conclusions: A significant proportion of AF patients received reduced doses of NOAC after ischemic stroke in a sizeable number of cases, without indication for dose reduction.