Akademik Veri Yönetim Sistemi
35. Turkish Cardiology Congress, Antalya, Türkiye, 3 - 06 Ekim 2019, ss.121
Background and Aim: Antithrombotic drugs are indicated in patients with atrial fibrillation (AF) to prevent
thromboembolic events. This study aimed to examine details of antithrombotic drug utilization in AF patients
who applied to a specialized heart center.
Methods: This cross-sectional study reviewed medical records of all patients applying to Istanbul Medical
Center of Turkish Heart Foundation between 1/1/16 and 6/30/18. The first record of AF for each patient was
analyzed with their demographics and drug use data. Antithrombotic drug utilization was compared based
on patients’ gender, age group (<75 vs. ≥75 years), and ischemic heart disease (IHD) presence.
Results: A total of 11,227 patients were found to visit the medical center during study period, with a mean
age of 51.5±21.9 years and females constituted 52.3%. Among this sample, 227 patients had AF (2.0%). These
patients had been prescribed a mean of 4.2±1.9 drugs per visit. AF patients were more likely to be women
(57.7%) and 52.4% of AF population were ≥75 years old (mean age: 74.6±11.5 years). IHD was detected
in 30.4% of AF patients. Antithrombotic drugs formed 24.6% of all the drug used, yielding an antithrombotic use of 1.0±0.5 per AF patient. The most frequently encountered antithrombotics were detected as
acetylsalicylic acid (ASA) (28.6%) and warfarin (27.7%), followed by rivaroxaban (19.5%), apixaban (8.2%),
dabigatran (6.5%), and clopidogrel (5.2%). The comparison of the antithrombotic drug utilization by sex only
showed significantly higher clopidogrel use among men vs. women (4.0% vs. 1.3%, respectively; p<0.05). AF
patients who received direct oral anticoagulants (DOACs) were more likely be older (76.9±9.9 years) than
those on warfarin (72.5±11.7 years; p<0.05). The percentages of warfarin, DOAC, or antiplatelet therapy use
did not significantly differ between those <75-year-old and ≥75-year-old. The AF patients with comorbid IHD
were found to use clopidogrel significantly more frequently (12.7%) than did those without (2.6%, p<0.05).
No difference was detected in terms of other antithrombotics by IHD status of AF patients. Around one in
ten AF patients (10.6%) were receiving multiple antithrombotics: three patients were managed with triple
antithrombotics and the remaining with dual therapy, 54.2% of which consisted of the combination of an oral
antiplatelet and an oral anticoagulant. ASA (n=17) and warfarin (n=9) were the most commonly encountered
drugs in multiple antithrombotic users. Multiple antithrombotic use was significantly more common with
concomitant IHD (22.2%) vs. without (6.1%; p<0.05).
Conclusions:This study shows comparable use of DOACs to warfarin or ASA though the latter therapies are
recommended to be less preferable in current AF guidelines. It seems that DOAC utilization is slightly more
predominant in elderly and not impacted by associated IHD. These findings indicate the need for designing
more comprehensive research to investigate antithrombotic drug utilization in AF patients.