Fácila Lorenzo, Cordero Alberto, Valverde Tavira Adrián, Rilo Miranda Irene, Laskibar Asua Alain, Tirapu Laia, Montagud Vicente, Sánchez-Serna Juan, Gómez-Mariscal Eloy, Mainar Luis, Martín Dorado Ernesto, Lorenzo Natalia, Pello Lázaro Ana María, Rodríguez-Mañero Moisés
Department of Cardiology, Hospital General Universitario de Valencia, Valencia, Spain.
Faculty of Medicine, Universitat de Valencia, Valencia, Spain.
Int J Cardiol Heart Vasc. 2025 Mar 1;57:101639. doi: 10.1016/j.ijcha.2025.101639. eCollection 2025 Apr.
This study described the clinical and demographic characteristics of hospitalized patients with nonvalvular atrial fibrillation (NVAF) and prescriptions for vitamin-K antagonists (VKA) and direct-acting oral anticoagulants (DOAC) in Spain.
This was an observational, multicentric, retrospective study of patients treated with DOAC or VKA due to NVAF at cardiology services of hospitals in Spain. A registry (CARISMA) included patients hospitalized for any reason and discharged before July 1st, 2021, with a prescription for DOAC or VKA. Data was collected on demographic and clinical characteristics and anticoagulant treatments prescribed. Analyses were descriptive.
A total of 1,041 patients were included. Mean age (SD) was 77.2 (10.3) years and 57.6 % were men. The most frequent reason for hospital admission was heart failure (43.8 %) and arrhythmias (25.0 %). The mean (SD) CHADS-VASc score was 4.0 (1.6). Prior to admission, 75.6 % of patients had been prescribed anticoagulant treatment for NVAF. Of these, 56.0 % had received VKA and 44.0 % DOAC. At discharge, 60 % had a DOAC prescription (of these, apixaban, 37.6 %; edoxaban, 26.4 %; rivaroxaban, 25.1 %; dabigatran, 10.9 %) and 40 % a VKA. DOAC prescriptions were off-label with respect to dosing in 19-34 % of cases. Patients with off-label dosing were older and with a higher proportion of women than those with on-label doses. During hospitalization, 12.1 % of patients changed treatment, usually VKA to DOAC.
Before hospitalization, a quarter of patients with NVAF were not receiving anticoagulation medication. Hospitalization increased the proportion of patients receiving DOAC, but about a quarter of patients had off-label dosing prescriptions.
本研究描述了西班牙非瓣膜性心房颤动（NVAF）住院患者的临床和人口统计学特征，以及维生素K拮抗剂（VKA）和直接口服抗凝剂（DOAC）的处方情况。
这是一项对西班牙医院心脏病科因NVAF接受DOAC或VKA治疗的患者进行的观察性、多中心、回顾性研究。一个登记处（CARISMA）纳入了因任何原因住院并于2021年7月1日前出院且有DOAC或VKA处方的患者。收集了人口统计学和临床特征以及所开抗凝治疗的数据。分析为描述性分析。
共纳入1041例患者。平均年龄（标准差）为77.2（10.3）岁，男性占57.6%。入院最常见的原因是心力衰竭（43.8%）和心律失常（25.0%）。CHADS-VASc评分的平均值（标准差）为4.0（1.6）。入院前，75.6%的患者因NVAF接受了抗凝治疗。其中，56.0%接受了VKA，44.0%接受了DOAC。出院时，60%有DOAC处方（其中，阿哌沙班占37.6%；依度沙班占26.4%；利伐沙班占25.1%；达比加群占10.9%），40%有VKA处方。19%至34%的DOAC处方在剂量方面属于超说明书用药。超说明书用药的患者比按说明书用药的患者年龄更大，女性比例更高。住院期间，12.1%的患者改变了治疗方案，通常是从VKA改为DOAC。
入院前，四分之一的NVAF患者未接受抗凝药物治疗。住院增加了接受DOAC治疗的患者比例，但约四分之一的患者有超说明书用药处方。
