Patient outcomes under new oral anticoagulants therapy in daily practice

Objective: Atrial fibrillation is the most common cardiac arrhythmia causing thromboembolism. Non-vitamin K oral anticoagulants (NOACs) have been demonstrated to be at least as effective and safe as warfarin. We aimed to assess the safety and efficacy of NOACs through real world experience. Design: Retrospective observational study Setting: Sakarya Education Hospital, Turkey Subjects: A total of 726 patients under NOACs therapy were included. Intervention: Demographic, clinical characteristics, bleeding and/or embolic events were analyzed. Main outcome measures: Patients were analyzed for the primary effectiveness outcome of ischemic stroke (IS)/systemic embolism and for the principal safety outcome of any bleeding events. Results: The mean age was 72.7 +/- 10 years and 62.5% were female. Embolic events were seen in 58 (8%) patients. Dabigatran, apixaban, rivaroxaban, edoxaban as well as low doses of these drugs had equal effectivity. Although CHA2DS2-VASc (P<0.001) and HASBLED (P=0.002) scores as well as malignancy (P=0.012) were statically significant in recurrent cerebrovascular events, only previous IS or transient ischemic attack (HR:7.246; 95%CI: 1.201-43.478; r=0.267; P<0.001) were predictive. Major bleeding was noted in 18 (2.5%) patients with low glomerular filtration rate (P=0.009), high CHA2DS2-VASc (P=0.002) and high HASBLED score (P=0.01). Age was the main determinant of bleeding (HR:1.090; 95%CI: 1.025-1.158; r=0.139; P=0.006), and bleeding was increasing significantly over 75 years (HR:5.025; 95%CI: 1.457-17.241; r=0.144; P=0.003). Conclusion: High CHA2DS2-VASc and HASBLED scores, and low CrCl were risk for thromboembolic and hemorrhagic complications. Advanced age was main determinant of safety in NOACs use. NOACs prescription and dose adjustment should be made according to the patient's clinical characteristics.