What is the clinical evidence from this study?

Study design: Observational. Population: nonvalvular atrial fibrillation (NVAF) (n=1446). Intervention: DOACs vs. VKAs and no anticoagulation. Primary outcome: Adequacy of anticoagulation therapy.

What question did this study set out to answer?

This study aims to assess the adequacy of anticoagulation therapy in clinical practice among patients with newly diagnosed nonvalvular atrial fibrillation.

February 28, 2026

Adequacy of anticoagulation in patients with nonvalvular atrial fibrillation

Resultado clave

In patients with newly diagnosed nonvalvular atrial fibrillation, anticoagulation therapy was adequate in 75% of those receiving DOACs, compared to 33% receiving VKAs.

Puntos clave

This study aims to assess the adequacy of anticoagulation therapy in clinical practice among patients with newly diagnosed nonvalvular atrial fibrillation.
Retrospective observational study conducted in Alava
Assessed the adequacy of direct-acting oral anticoagulants and vitamin K antagonists based on specified guidelines
Utilized univariate and multivariate logistic regression analyses to determine probability of inadequacy.
75% of patients on direct-acting oral anticoagulants had adequate therapy compared to 33% on vitamin K antagonists
Inadequacies were mainly due to inappropriate dosing, affecting 25% of DOAC patients and 67% of VKA patients
43% of untreated patients lacked adequate reasons for not receiving anticoagulation.

Diseño del estudio

Tipo

Observational (n=1,446)

PICO estructurado

What is the adequacy of anticoagulation therapy in patients with newly diagnosed nonvalvular atrial fibrillation in routine clinical practice?

Población

1446 patients with newly diagnosed nonvalvular atrial fibrillation (NVAF) in Alava

Intervención

Anticoagulation therapy (direct-acting oral anticoagulants [DOACs] or vitamin K antagonists [VKAs]) or no anticoagulation

Resultado

Adequacy of anticoagulation therapy (DOAC dose per summary of product characteristics, VKA time in therapeutic range ≥60%, or clinical justification for no anticoagulation)

There is marked inadequacy in anticoagulation prescribing for NVAF in routine clinical practice, particularly with VKAs, highlighting the need for stricter adherence to guidelines.

Resultado numérico

Tasa de eventos absoluta: 75% vs 33%

Resumen

OBJECTIVE Fewer benefits are obtained from antithrombotic therapy in nonvalvular atrial fibrillation (NVAF) in routine practice than in clinical trials due to inadequate prescribing. This study aimed to assess the adequacy of anticoagulation therapy in clinical practice in patients with newly diagnosed NVAF. METHODS A retrospective observational study was conducted to assess treatment adequacy in patients with newly diagnosed NVAF in Alava. The adequacy of direct-acting oral anticoagulant (DOAC) therapy was classified according to the dose specified in the summary of product characteristics. In patients treated with vitamin K antagonists (VKAs), anticoagulation therapy quality was considered good when the time in the therapeutic range (international normalised ratio: 2.0-3.0) was ≥60%. Univariate and multivariate logistic regression analyses were performed to analyse the probability of inadequacy. RESULTS Overall, 1446 patients with NVAF were included: 408 (28%) were treated with DOACs, and 856 (59%) with VKAs, while 182 (13%) received no anticoagulation therapy. The treatment was considered adequate in 75% of the DOAC group, 33% of the VKA group, and 57% of the no-anticoagulant group. The reason for inadequacy in treated patients was receiving an inappropriate dose of DOACs (25%) or VKAs (67%), while in the untreated group, 78 cases (43%) were classified as inadequate due to lack of anticoagulation with no clinical justification. CONCLUSIONS There is marked variability in the adequacy of anticoagulation in patients with NVAF. Guideline recommendations should be strictly followed to improve treatment adequacy, as it is unacceptable that half of these patients are inadequately anticoagulated.

Me gusta

Guardar