Impact of new criteria for anticoagulant treatment in atrial fibrillation

Introduction and objectives

The guidelines for the management of atrial fibrillation (AF) incorporate new risk factors for thromboembolism, trying to de-emphasize the use of the ‘low’, ‘moderate’, and ‘high’ risk categories. The objective of this study was to determine the impact of the new scheme CHA₂DS₂-VASc and of the new recommendations for oral anticoagulation (OAC) in a contemporary sample of patients with AF seen by primary physicians and cardiologists.

Methods

Multicenter, observational, cross-sectional study on the epidemiology of hypertension and its control, designed by the arterial hypertension department. Each researcher enrolled the first 6 consenting patients who came for examination during a 5-day period.

Results

Of 25 137 individuals recruited, 1544 were diagnosed with AF. The vast majority of the sample had a CHADS₂ score ≥2 (77.3%). Individuals with a risk score lower than 2 were categorized according to the CHA₂DS₂-VASc score: 14.4% were aged 75 years or older (CHA₂DS₂-VASc = 2). Of those younger than 75, 42.3% had a CHA₂DS₂-VASc = 2; 23.7% CHA₂DS₂-VASc = 3, and 1.1% CHA₂DS₂-VASc = 4. This means that the 85.1% of the patients with a CHADS₂ score <2 and no contraindications are indicated for OAC.

Conclusions

The new recommendations will result in a significant increase in patients with indications for OAC, at the expense of those previously characterized as low-to-moderate risk. Therefore, patients at risk of thromboembolic events must be identified, although an evaluation of bleeding risk should be part of the patient assessment before starting anticoagulation.Full English text available from: www.revespcardiol.org