Clifford Cole, Goodman Shaun G, Tan Mary K, Gregoire Jean, Habert Jeffrey, Gupta Anil, Chow Walter, Jaffer Shahin, Aggarwal Sandeep G, Heffernan Michael, Maranda Robert, Saunders Kevin, Yan Andrew T
University of Toronto, Toronto, Ontario, Canada.
Division of Cardiology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
CJC Open. 2024 Dec 27;7(4):412-419. doi: 10.1016/j.cjco.2024.12.010. eCollection 2025 Apr.
Optimal thromboprophylaxis in atrial fibrillation (AF) requires the accurate application of modern clinical guidelines. We evaluated the point prevalence and factors associated with nonguideline-directed anticoagulation and direct oral anticoagulant (DOAC) dosing in Canadian patients with AF.
TRANSECT-AF is a retrospective registry of consecutive Canadian patients with AF collected between March 2021 and August 2023. Patients were categorized as guideline directed therapy (GDT) or nonguideline-directed therapy (NGDT) based on concordance of their reported thromboprophylaxis with the CHADS-65 algorithm. Patients on GDT with a DOAC were subcategorized as concordant or discordant dosing based on concordance of their reported DOAC doses with the 2020 Canadian Cardiovascular Society AF dosing recommendations.
In total, 3043 patients were included (median age 77, 37% women, median CHADS-VASc score 4, median HAS-BLED score 2) and 11% received NGDT, which was independently associated with younger age, lower thromboembolic risk, better renal function, and antiplatelet therapy. Within the GDT cohort, 32% of patients were on guideline discordant DOAC doses. Older age, lower body mass index, female sex, lower renal function, higher thromboembolic risk and non-apixaban DOAC use were independently associated with discordant dosing.
Within this Canadian AF registry, 11% of patients were on NGDT and 32% of patients on GDT with a DOAC were treated with a guideline-discordant dose. Our analysis describes predictors of guideline discordant anticoagulation and DOAC dosing that may be used to identify target populations for future quality improvement initiatives in AF thromboprophylaxis.
心房颤动（AF）的最佳血栓预防需要准确应用现代临床指南。我们评估了加拿大AF患者中未遵循指南的抗凝治疗及直接口服抗凝剂（DOAC）剂量的时点患病率和相关因素。
TRANSECT-AF是一项对2021年3月至2023年8月期间连续纳入的加拿大AF患者的回顾性登记研究。根据患者报告的血栓预防措施与CHADS-65算法的一致性，将患者分为指南指导治疗（GDT）组或非指南指导治疗（NGDT）组。接受GDT且使用DOAC的患者，根据其报告的DOAC剂量与2020年加拿大心血管学会AF剂量推荐的一致性，进一步分为剂量相符组或剂量不符组。
共纳入3043例患者（中位年龄77岁，37%为女性，中位CHADS-VASc评分为4，中位HAS-BLED评分为2），11%接受NGDT，这与年龄较小、血栓栓塞风险较低、肾功能较好及抗血小板治疗独立相关。在GDT队列中，32%的患者DOAC剂量与指南不符。年龄较大、体重指数较低、女性、肾功能较低、血栓栓塞风险较高及使用非阿哌沙班DOAC与剂量不符独立相关。
在这个加拿大AF登记研究中，11%的患者接受NGDT，在接受GDT且使用DOAC的患者中，32%接受了与指南不符的剂量。我们分析了与指南不符的抗凝治疗及DOAC剂量的预测因素，这些因素可用于识别未来AF血栓预防质量改进计划的目标人群。
