Comparison of clinical characteristics of real-life atrial fibrillation patients treated with vitamin K antagonists, dabigatran and rivaroxaban: results from the CRAFT study.

BACKGROUND The first line drugs for treatment of non-valvular atrial fibrillation (AF) are non-vitamin K oral anticoagulants (NOACs), which are preferred over vitamin K antagonists (VKAs). There is some evidence that an everyday clinical practice is distant from the guidelines. AIM The study aimed to compare characteristics of patients on VKAs, dabigatran and rivaroxaban met in everyday practice (i.e. baseline characteristics, drugs' doses, risk factors of bleeding and thromboembolic events). Additionally, we assessed a frequency of prescription of different oral anticoagulants (OACs) in recent years. METHODS This study consisted of data from the multicentre CRAFT (MultiCentre expeRience in AFib patients Treated with OAC) study (NCT02987062). This was a retrospective analysis of hospital records of AF patients (hospitalized in years 2011-2016) treated with VKAs (acenocoumarol, warfarin) and NOACs (dabigatran, rivaroxaban). In the CRAFT study were enrolled 3 528 patients with non-valvular AF. RESULTS The total cohort consisted of 1 973 patients on VKA, 504 patients on dabigatran and 1 051 patients on rivaroxaban. Patients on rivaroxaban were older (70.5 ± 13.1 years) and more likely female (47.9%), compared with patients on VKAs (67.0 ± 12.8 years, p < 0.0001; 35.5%, p < 0.0001) and on dabigatran (66.0 ± 13.9 years, p < 0.0001; 38.9%, p = 0.001). Among NOACs patients with persistent and permanent AF were more likely to receive rivaroxaban (54.7% and 73.4%, respectively) than dabigatran (45.3%, p < 0.0001 and 26.6%, p = 0.002, respectively). Patients on rivaroxaban had higher risk of thromboembolic events (CHA2DS2VASc 3.9 ± 2.0, CHADS2 2.2 ± 1.4) than on VKAs (3.3 ± 2.0, 1.9 ± 1.3) and on dabigatran (3.1 ± 2.0, 1.8 ± 1.3). Patients on rivaroxaban had also a higher rate of prior major bleeding (11.2%) than patients on VKAs (6.7%, p < 0.0001) and on dabigatran (7.3%, p = 0.02). Patients on the lower doses of dabigatran and rivaroxaban had significantly higher risk of thromboembolic and bleeding events. Use of VKA in 2011 year was reported in over 96% of patients on OACs but it decreased to only 34.6% in 2016. In the last analysed year (2016) AF patients were treated mainly with NOACs - dabigatran (24.2%) and rivaroxaban (41.3%). CONCLUSIONS Prescription of VKAs had significantly declined since the introduction of NOACs. Patients treated with different OACs demonstrated a distinct baseline clinical profile. The highest risk of thromboembolic events and incidence of major bleedings were observed in patients on rivaroxaban in comparison to patients on VKAs and dabigatran. Among NOACs, patients treated with lower doses of dabigatran and rivaroxaban were older and had significantly higher risk of thromboembolic and bleeding events.