Demographic, clinical, and functional determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation
Authors: Mostaza Jose María , Suarez Carmen , Cepeda Jose María , Manzano Luis , Sánchez Demetrio ,   on behalf of the PERFILAR study investigators, Lora Fernando Javier Sánchez , Ibañez Bermúdez Francisco , Jurado Porcel Ana María , Salgado Ordoñez Fernando , Rivera Civico Francisco , Díez García Luis Felipe , Jaén Águila Fernando , Geraldía Lama Manuel , Peral Gutiérrez-Ceballos Enrique , Domínguez Antonia , Astudillo Martín Francisco , Aguilar Eduardo , Ferrando Vela Juan , García Aranda Alfonso , Sánchez Cembellín Mercedes , López Caleya Juan Francisco , Ruiz Sixto , Rodríguez Gaspar Melchor , Conde Martel Alicia , Hernández Hernández José Luis , Abascal Carrera Ismael , Pérez del Molino Castellanos Alfonso , Fernández Pérez Esther , Martínez Acitores Juan Carlos , Cortes Luis Miguel Seisdedos , Abad Manteca Laura , Budiño Sánchez Marco , Moreno Palomares José Javier , Coca Prieto Inmaculada , Muñoz Ana Isabel , Sánchez Castaño Ángel , Ruiz Ribó Lola , Mascaró Jordi , Morcillo Serra César , Auguet Quintillá Teresa , Marimón Francesz , Fernández Solá Joaquín , Suriñach José María , Marchena Pablo , Riera-Mestre Antoni , Armario Pedro , García Bragado Ferrán , del Molino Fátima , Sacristán Oscar , Almagro Pere , Falgà Conxita , Rodríguez Francisco José Muñoz , Riesco  , Romero Requena Jorge , Arévalo Lorido José Carlos , Chiquero Palomo Manuela , de la Cruz Ana Isabel , Pijerro Agustín , Fernández Bouza Elena , González Soler Juan José , Núñez Fernández Manuel Jesús , De La Fuente Aguado Javier , Díaz Peromingo José Antonio , Fernández Martín Julián , Daroca Pérez Rafael , Castiella Herrero Jesús , Carreño M. Cruz , Gómez Cerezo Jorge , Pontes Navarro José Carlos , Varona Arche José Felipe , Ferreiro López Daniel , Muñoz Calvo Benjamín , Casado Cerrada Jesús Manuel , Fidalgo Montero María del Pilar , Casas Rojo José Manuel , Herreros Benjamín , Cuevas Tascón Guillermo , Muiño Miguez Antonio , Marrero Francés Jorge , Ortega Nicolas , Trujillo Javier , Sánchez Álvarez Julio , Catalán Ramos Jose Ignacio , Fresco Benito Francisco Javier , Anuzita Alegría Ainhoa , Teruel Carlos , Artero Mora Arturo , Moral Pedro , Seguí Ripoll José Miguel , Bonilla Rovira Fernando , Maestre Peiro Ana 
Published: August 2021

Abstract
Background
This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting.

Methods
A multicenter, cross-sectional study was conducted in NVAF patients who attended internal medicine departments for either a routine visit (outpatients) or hospitalization (inpatients).

Results
A total of 961 patients were evaluated. Their antithrombotic management included: no treatment (4.7%), vitamin K antagonists (VKAs) (59.6%), direct oral anticoagulants (DOACs) (21.6%), antiplatelets (6.6%), and antiplatelets plus anticoagulants (7.5%). Permanent NVAF and congestive heart failure were associated with preferential use of oral anticoagulation over antiplatelets, while intermediate-to high-mortality risk according to the PROFUND index was associated with a higher likelihood of using antiplatelet therapy instead of oral anticoagulation. Longer disease duration and institutionalization were identified as determinants of VKA use over DOACs. Female gender, higher education, and having suffered a stroke determined a preferential use of DOACs.

Conclusions
This real-world study showed that most elderly NVAF patients received oral anticoagulation, mainly VKAs, while DOACs remained underused. Antiplatelets were still offered to a proportion of patients. Longer duration of NVAF and institutionalization were identified as determinants of VKA use over DOACs. A poor prognosis according to the PROFUND index was identified as a factor preventing the use of oral anticoagulation.