Risikoadaptierte Antikoagulation zur Schlaganfallprävention bei Vorhofflimmern in Deutschland, Österreich und der Schweiz: Analyse des PREFER-in-AF-Registers

Abstract

Background: The management of patients with atrial fibrillation (AF) has substantially improved in recent years, among others due to the introduction of new risk scores for the stratification of patients, as well as the availability of the non-Vitamin K oral antagonists (NOAC). The PREFER-in-AF study aimed to document the management of AF patients with particular focus on stroke prevention on the basis of anticoagulants. Methods and results: In Germany, Austria and Switzerland a total of 1771 patients were enrolled between January 2012 and January 2013 (mean age 71.9 ± 9.2 years; 63 % males). At inclusion, the mean time since AF diagnosis was 4.8 ± 5.3 years. Paroxysmal AF was present in 30.7 %, persistent in 11 %, long standing persistent in 4.7 % and permanent AF in 53.3 % of the patients. 25.1 % of the Patients were in sinus rhythm. Mean CHA2DS2-VASc Score was 3.7 ± 1.8 points (0 points in 3.0 %, 1 point in 7.1 %, ≥ 2 points in 89.9 %). For the prevention of thromboembolic events 68.1 % of patients received Vitamin K antagonists (VKA, mainly phenprocoumon), 11.6 % received a NOAC (mainly rivaroxaban or dabigatran), 7.6 % an antiplatelet agent, and 7.7 % a combination of VKA plus an antiplatelet agent. 5.0 % of patients did not receive any anticoagulant. During the 12 months prior to inclusion, interruption of VKA therapy due to an interventions was reported in 29.7 %. In the group of patients with known INR values and available CHA2DS2-VASc score, 75.1 % were adequately controlled (defined as at least 2 of 3 INR values in the range of 2.0-3.0). Bleeding propensity or bleedings in patient history were reported for 5.1 % of the patients, hospitalizations due to major bleeding events in the past 12 months for 1.9 %. Possible risk factors associated with anticoagulation were present in 76.7 %. Mean HAS-BLED score was 2.1 ± 1.1 points. Conclusion: The rates of AF patients who received oral anticoagulation were about 90 % and substantially higher compared to previous observational studies. NAOCs were administered to 11.7 % of patients.