Oral Anticoagulant Use and Long-Term Follow-Up Results in Patients with Non-valvular Atrial Fibrillation in Turkey AFTER-2 Study

Abstract

Background : The aim of this study was to investigate the frequency of oral anticoagulant drugs and time in therapeutic range in patients receiving warfarin in addition to the epidemiological trial of non-valvular atrial fibrillation previously conducted in Turkey (The Atrial Fibrillation: Epidemiological Registry trial). Furthermore, the prevalence of major adverse events and mortality rates of the patients were evaluated during the long-term follow-up period. Methods: We created a national data registry for non-valvular atrial fibrillation patients, reflecting all geographic regions by population density. In that context, the study included all consecutive atrial fibrillation patients older than 18 years of age who were admitted to the cardiology outpatient clinic except for patients those with prosthetic heart valves and rheumatic mitral valve stenosis. Results: This study included 2592 patients from 35 different centers. The mean age was 68.7 ± 11.1 years, and 55.5% of the patients were female. The most common comorbid diseases were chronic kidney disease (69%) and hypertension (65.5%). The time in therapeutic range rate in the general population was 40%, and the mortality rate at 5-year follow-up was 29.4%. Conclusion: The Atrial Fibrillation: Epidemiological Registry 2 study showed higher use of anticoagulant in non-valvular atrial fibrillation patients than in previous national studies. Furthermore, this study demonstrated that most of the non-valvular atrial fibrillation patients are in the high-risk group and the time in therapeutic range rates are still low in Turkey. As a result, this is a significant reason for switching from warfarin to non-K vitamin-dependent new oral anticoagulant treatments.

Comparison of the real-life clinical outcomes of warfarin with effective time in therapeutic range and non-vitamin K antagonist oral anticoagulants: Insight from the AFTER-2 trial

“…Moreover, it has been shown that the clinical effectiveness of VKA decreases sharply as TTR falls below 65% compared to antiplatelets [7]. In the AFTER-2 study, the mean TTR of the patients was 40%, and only 31.4% of the patients' TTR values were in the effective range [13]. INR measurements should be done more frequently to improve VKA management, but this implies additional costs for laboratory resources [16].…”

“…The study is a subgroup analysis of the trial: "Oral Anticoagulant Use and Long-Term Follow-Up Results in Patients with Non-valvular Atrial Fibrillation in Turkey AFTER-2" [13].…”

Reply to Letter to the Editor: “Anticoagulation in Real-Life Patients with Atrial Fibrillation: Impact of Renal Disease”

“…Therefore, we found that the most common comorbid condition in patients was CKD. 13 In addition, we had 327 (12.6%) patients with GFR ≥ 90, 479 (18.5%) patients with 60 ≤ GFR < 90, 1141 (44%) patients with 30 ≤ GFR < 60, 499 (19.3%) patients with 15 ≤ GFR < 30, and 146 (5.6%) patients with GFR < 15. Among our patient population, rivaroxaban was the most commonly used NOACs, followed by dabigatran.…”

Anticoagulation in Real-Life Patients with Atrial Fibrillation: Impact of Renal Disease

“…In the latest issue of The Anatolian Journal of Cardiology , I have read with keen interest the article by Güzel et al 1 showing the current anticoagulation practice among atrial fibrillation (AF) patients in Turkey. In The Atrial Fibrillation: Epidemiological Registry (AFTER)-2 registry involving 2592 outpatients with AF at a mean age of 69 years, the majority of whom represented the high-risk group, the authors reported a marked increase in the proportion of anticoagulated individuals in recent years up to almost 73%, with 42% on direct oral anticoagulants (most commonly on rivaroxaban) and 31% on warfarin (unfortunately, with a low time in therapeutic range of 40%).…”

“…In The Atrial Fibrillation: Epidemiological Registry (AFTER)-2 registry involving 2592 outpatients with AF at a mean age of 69 years, the majority of whom represented the high-risk group, the authors reported a marked increase in the proportion of anticoagulated individuals in recent years up to almost 73%, with 42% on direct oral anticoagulants (most commonly on rivaroxaban) and 31% on warfarin (unfortunately, with a low time in therapeutic range of 40%). 1 From the practical perspective, right dosing regimens of nonvitamin K antagonist oral anticoagulants (NOACs) are of key importance to avoid common and dangerous underdosing as well as infrequent overdosing. 2 …”