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

Anna Szyszkowska, Łukasz Kuźma, Beata Wożakowska-Kapłon, Iwona Gorczyca-Głowacka, Olga Jelonek, Beata Uziębło-Życzkowska, Paweł Krzesiński, Maciej Wójcik, Robert Błaszczyk, Monika Gawałko, Agnieszka Kapłon-Cieślicka, Tomasz Tokarek, Renata Rajtar-Salwa, Jacek Bil, Michał Wojewódzki, Anna Szpotowicz, Małgorzata Krzciuk, Janusz Bednarski, Elwira Bakuła, Marcin Wełnicki, Artur Mamcarz and Anna Tomaszuk-Kazberuk ()
Additional contact information
Anna Szyszkowska: Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland
Łukasz Kuźma: Department of Invasive Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland
Beata Wożakowska-Kapłon: 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
Iwona Gorczyca-Głowacka: 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
Olga Jelonek: 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
Beata Uziębło-Życzkowska: Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland
Paweł Krzesiński: Department of Cardiology and Internal Diseases, Military Institute of Medicine, 04-141 Warsaw, Poland
Maciej Wójcik: Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland
Robert Błaszczyk: Department of Cardiology, Medical University of Lublin, 20-059 Lublin, Poland
Monika Gawałko: 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
Agnieszka Kapłon-Cieślicka: 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
Tomasz Tokarek: Center for Invasive Cardiology, Electrotherapy and Angiology, 38-400 Nowy Sacz, Poland
Renata Rajtar-Salwa: Cardiology and Cardiovascular Interventions Clinical Department, The University Hospital, 30-688 Krakow, Poland
Jacek Bil: Department of Invasive Cardiology, Center of Postgraduate Medical Education, 02-776 Warsaw, Poland
Michał Wojewódzki: Department of Invasive Cardiology, Center of Postgraduate Medical Education, 02-776 Warsaw, Poland
Anna Szpotowicz: Department of Cardiology, Regional Hospital, 27-400 Ostrowiec Swietokrzyski, Poland
Małgorzata Krzciuk: Department of Cardiology, Regional Hospital, 27-400 Ostrowiec Swietokrzyski, Poland
Janusz Bednarski: Department of Cardiology, St. John Paul’s II Western Hospital, 05-825 Grodzisk Mazowiecki, Poland
Elwira Bakuła: Department of Cardiology, St. John Paul’s II Western Hospital, 05-825 Grodzisk Mazowiecki, Poland
Marcin Wełnicki: 3rd Department of Internal Diseases and Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
Artur Mamcarz: 3rd Department of Internal Diseases and Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
Anna Tomaszuk-Kazberuk: Department of Cardiology, Medical University of Bialystok, 15-276 Bialystok, Poland

IJERPH, 2022, vol. 19, issue 19, 1-13

Abstract: 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 CHA 2 DS 2 -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.

Keywords: atrial fibrillation; ischemic stroke; anticoagulation; reduced dose (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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