Clinical outcomes in patients with atrial fibrillation treated with DOACs in a specialized anticoagulation center : Critical appraisal of real-world data
Moret, Carla (Institut d'Investigació Biomèdica Sant Pau)
Acosta-Isaac, René (Institut d'Investigació Biomèdica Sant Pau)
Mojal, Sergi (Institut d'Investigació Biomèdica Sant Pau)
Corrochano, Mariana (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Jiménez, Blanca (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Plaza, Melania (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Souto, Juan Carlos (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona

Data:	2023
Resum:	Direct oral anticoagulants (DOAC) are progressively replacing vitamin K antagonists in the prevention of thromboembolism in patients with atrial fibrillation. However, their real-world clinical outcomes appear to be contradictory, with some studies reporting fewer and others reporting higher complications than the pivotal randomized controlled trials. We present the results of a clinical model for the management of DOACs in real clinical practice and provide a review of the literature. The MACACOD project is an ongoing, observational, prospective, single-center study with unselected patients that focuses on rigorous DOAC selection, an educational visit, laboratory measurements, and strict follow-up. A total of 1,259 patients were included. The composite incidence of major complications was 4. 93% py in the whole cohort vs 4. 49% py in the edoxaban cohort. The rate of all-cause mortality was 6. 11% py for all DOACs vs 5. 12% py for edoxaban. There weren't differences across sex or between Edoxaban reduced or standard doses. However, there were differences across ages, with a higher incidence of major bleeding complications in patients >85 years (5. 13% py vs 1. 69% py in <75 years). We observed an incidence of serious complications of 4. 93% py, in which severe bleeding predominated (3. 65% py). Considering our results, more specialized attention seems necessary to reduce the incidence of severe complications and also a more critical view of the literature. Considering our results, and our indirect comparison with many real-world studies, more specialized attention seems necessary to reduce the incidence of severe complications in AF patients receiving DOACs.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Administration, Oral ; Aged, 80 and over ; Anticoagulants ; Atrial Fibrillation ; Humans ; Prospective Studies ; Pyridines ; Stroke
Publicat a:	PloS one, Vol. 18 Núm. 2 February (february 2023) , p. e0279297, ISSN 1932-6203

DOI: 10.1371/journal.pone.0279297
PMID: 36827286

19 p, 760.2 KB

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