Suboptimal oral anticoagulation in patients with nonvalvular atrial fibrillation and history of cerebrovascular disease in Mexico. Results from CARMEN-AF Registry

BACKGROUND: Atrial fibrillation (AF) increases the risk of stroke, especially in patients with previous cerebrovascular disease. This risk is significantly reduced with oral anticoagulants (OAC), with direct oral anticoagulants (DOACs) being the optimal treatment. OBJECTIVES: To study the most used anticoagulant treatment in patients with nonvalvular AF (NVAF) with and without cerebrovascular disease in Mexico. METHODS: CARMEN-AF is a national, multicentric observational registry that includes 1423 patients with AF. Patients were recruited regardless of the anticoagulant therapy. Demographics, clinical variables, comorbidities and antithrombotic treatment were compared among patients with and without a history of cerebrovascular disease. RESULTS: Of the 238 patients with a previous cerebrovascular disease (average age 69±13 years; 114 women [48.5%]), 99% had a previous ischemic stroke. In this subgroup, the type of AF was permanent 43.4%, persistent 20%, and paroxysmal AF was 36.6%. Principal comorbidities were hypertension 77.9%, diabetes mellitus 29.8%, and heart failure 20%. Nearly 12.4% of patients with a history of ischemic cerebrovascular disease did not receive anticoagulant (AC) treatment. Among those who did, vitamin K antagonists (VKAs) were more commonly prescribed than DOACs (37.4% vs. 25.5%). CONCLUSION: In Mexico, anticoagulation rates remain low among patients with NVAF and a history of cerebrovascular disease.