• Hyun Su Ha, Joongmin Kim, Young Soo Lee, Tae Hoon Kim, Jung Myung Lee, Junbeom Park, Jin Kyu Park, Ki Woon Kang, Jaemin Shim, Jae Sun Uhm, Hyung Wook Park, Myung Jin Cha, Eue Keun Choi, Jun Kim, Jin Bae Kim, Changsoo Kim, and Boyoung Joung.
• Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
• Yonsei Med. J. 2020 Feb 1; 61 (2): 120-128.

PurposeStroke prevention in patients with atrial fibrillation (AF) is influenced by many factors. Using a contemporary registry, we evaluated variables associated with the use of warfarin or direct oral anticoagulants (OACs).Materials And MethodsIn the prospective multicenter CODE-AF registry, 10529 patients with AF were evaluated. Multivariate analyses were performed to identify variables associated with the use of anticoagulants.ResultsThe mean age of the patients was 66.9±14.4 years, and 64.9% were men. The mean CHA₂DS₂-VASc and HAS-BLED scores were 2.6±1.7 and 1.8±1.1, respectively. In patients with high stroke risk (CHA₂DS₂-VASc ≥2), OACs were used in 83.2%, including direct OAC in 68.8%. The most important factors for non-OAC treatment were end-stage renal disease [odds ratio (OR) 0.27; 95% confidence interval (CI): 0.19-0.40], myocardial infarct (OR 0.53; 95% CI: 0.40-0.72), and major bleeding (OR 0.57; 95% CI: 0.39-0.84). Female sex (OR 1.40; 95% CI: 1.21-1.61), cancer (OR 1.78; 95% CI: 1.38-2.29), and smoking (OR 1.60; 95% CI: 1.15-2.24) were factors favoring direct OAC use over warfarin. Among patients receiving OACs, the rate of combined antiplatelet agents was 7.8%. However, 73.6% of patients did not have any indication for a combination of antiplatelet agents.ConclusionRenal disease and history of valvular heart disease were associated with warfarin use, while cancer and smoking status were associated with direct OAC use in high stroke risk patients. The combination of antiplatelet agents with OAC was prescribed in 73.6% of patients without definite indications recommended by guidelines.© Copyright: Yonsei University College of Medicine 2020.

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