Utilization of Anticoagulants in Nonvalvular Atrial Fibrillation Before andAfter Catheter Ablation at Shanghai China

摘要

Both vitamin K antagonists (VKAs) and novel oral anticoagulants (NOACs) are effective for stroke prevention in nonvalvular atrial fibrillation (NVAF) patients. This study evaluated the utilization of VKA and NOACs in NVAF patients before and after catheter ablation in China. Prescription data were retrospectively collected between January 1, 2016, and December 31, 2016, including indication of use, dose, renal function, and risk assessment (CHA2DS2-VASc score and HAS-BLED score) in Zhongshan Hospital of Fudan University. Trends and factors associated with anticoagulants use before and after ablation were evaluated. A total of 475 patients with NVAF who received ablation were included in the analysis. Of all, 53.26% of them received antithrombotic therapy preablation. Warfarin was prescribed in 35.26%, with NOACs in 11.37%. Four hundred seventy-three patients received antithrombotic therapy (99.58%) postablation, 236 patients with NOACs (49.68%). CHA2DS2-VASc score, HAS-BLED score, hypertension, diabetes mellitus, and alcohol were independently associated with anticoagulant utilization before catheter ablation. The higher CHA2DS2-VASc score was associated with less frequent prescription of NOACs postablation. The preablation anticoagulation use was still inadequate in China, and CHA2DS2-VASc score was a significant factor influencing thepreablation anticoagulant utilization. The utilization rate of NOACs increasedsignificantly postablation, especially for dabigatran, which implied that more physiciansprefer to prescribe NOACs for NVAF patients after ablation in our country and may beattributed to the aspects such as ease of NOAC use but also possibly the greater safetyand efficacy. Furthermore, the physicians may reluctant to use NOACs for high stroke riskatrial fibrillation patients after catheter ablation.