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Clinical Cardiology Journal

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Predictors of thromboembolic and bleeding complications in patients with non-valvular atrial fibrillation and atrial flutter using vitamin K antagonists or non-vitamin K antagonist oral anticoagulants A cross sectional study

Author(s): Natasa Jankovic*, Jovana Kuzmanovic Pficer, Biljana Pantic, Dragan Simic MD and Vedrana Pavlovic

Background: Most common complications that could occur due to inadequate anticoagulant therapy are different types of bleeding or thromboembolic events.

Objectives: The aim of this study was to identify differences between patients using a different anticoagulant therapy and the occurrence of complications and their frequency. The second aim was to determine the predictors that may lead to these complications using the regression model.

Methods and Results: We conducted a cross-sectional study. In total, 1401 AF/AFL patients were identified with prescriptions to either VKA or NOAC. Duration of follow-up was 22.5 months. The results showed no significant differences between NOAC and VKA users for ischaemic stroke or systemic embolism. On the other hand, in the VKA group, there were two times more fatal outcomes than in the NOAC group (p=0.002). Also, combined endpoint (stroke/systemic embolism/death) was statistically higher in the VKA group (p=0.039). We found a statistically significant difference in the rate of “total bleeding” between groups (NOAC: 7.6%, VKA group: 17.2%, p<0.001). Regression model identified that the factors that increased bleeding events were female gender, a higher level of creatinine and percutaneous coronary intervention, while usage of NOAC was related to a statistically significant reduction of bleeding (p<0.001).

Conclusion: This study shows that NOAC are an effective and safe alternative to VKA in clinical care settings. Individual patient characteristics including renal function, age or prior bleeding should be taken into account when choosing the VKA/NOAC with the best risk-benefit profile.

Keywords: Atrial fibrillation/flutter, Thromboembolism, Bleeding, Oral anticoagulants

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Citations : 16

Clinical Cardiology Journal received 16 citations as per Google Scholar report