PMID- 34221150
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20211028
IS  - 1841-9038 (Print)
IS  - 2069-6116 (Electronic)
IS  - 1841-9038 (Linking)
VI  - 16
IP  - 1
DP  - 2021 Mar
TI  - Antithrombotic Strategies in Invasively Managed Patients with Non-ST Elevation 
      Acute Coronary Syndromes and Non-Valvular Atrial Fibrillation in Romania.
PG  - 6-15
LID - 10.26574/maedica.2020.16.1.6 [doi]
AB  - Introduction: Concomitant atrial fibrillation (AF) in non-ST segment elevation 
      acute coronary syndrome (NSTE-ACS) patients complicates the decision-making 
      process regarding short- and long-term antithrombotic strategies. Patient 
      profiles and usage rates of different antithrombotic combinations in this patient 
      subgroup in Romania are poorly described. Premises and objectives: To describe 
      the characteristics of invasively managed NSTE-ACS patients with AF (either known 
      or newly diagnosed) compared to patients with no oral anticoagulation (OAC) 
      indications, and analyze the rates and factors that influence the different 
      antithrombotic regimens at discharge in AF patients. Material and methods: The 
      Romanian National NSTE-ACS Registry allows the enrollment of invasively managed 
      NSTE-ACS patients admitted in 11 interventional centers. Patients with 
      non-valvular AF and no other OAC indication were identified and compared with 
      patients with no indication for OAC. The antithrombotic strategy at discharge was 
      analyzed based on demographic, clinical, and invasive management characteristics. 
      Outcomes:A total of 1418 patients were enrolled between 2016 and 2019 out of 
      which, 175 AF subjects and 1159 patients with no OAC indication were included in 
      the analysis. Subjects with AF were older (70 +/- 8.3 vs 62.9 +/- 10.4 years, p 
      <0.001) and more likely to have a GRACE score >140 (aOR 2.28, 95% CI 1.58-3.31, 
      p<0.001), a history of heart failure (aOR 3.07, 95% CI 2.14-4.41, p <0.001), 
      dementia or Alzheimer disease (aOR 3.45, 95% CI 1.11-10.68, p 0.032), and 
      non-fatal major cardiovascular (CV) events during admission (aOR 6.71, 95% CI 
      1.61-27.94, p 0.009). Globally, triple antithrombotic therapy (TAT) was used in 
      52.5% of AF patients. 69% of PCI patients received TAT. One in four patients with 
      AF did not receive OAC at discharge. Prior treatment with OAC was the strongest 
      predictor for OAC usage at discharge (aOR 12.34, 95% CI 3.21-47.61, p<0.001). 
      Conclusion: More than one in 10 NSTE-ACS patients have a concomitant non-valvular 
      AF diagnosis. These patients are significantly older and are more likely to have 
      significant CV and non-CV disease. Triple antithrombotic therapy is the most used 
      antithrombotic strategy, especially in the PCI subgroup. One in four NSTE-ACS AF 
      patients do not receive OAC at discharge.
FAU - Cotoban, Alexandru George
AU  - Cotoban AG
AD  - "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
FAU - Udroiu, Cristian Alexandru
AU  - Udroiu CA
AD  - Emergency University Hospital Bucharest, Romania.
FAU - Vina, Radu
AU  - Vina R
AD  - Viami Software, Viami Solution SRL, Bucharest, Romania.
FAU - Vinereanu, Dragos
AU  - Vinereanu D
AD  - "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
LA  - eng
PT  - Editorial
PL  - Romania
TA  - Maedica (Bucur)
JT  - Maedica
JID - 101526930
PMC - PMC8224708
EDAT- 2021/07/06 06:00
MHDA- 2021/07/06 06:01
PMCR- 2021/03/01
CRDT- 2021/07/05 10:03
PHST- 2021/07/05 10:03 [entrez]
PHST- 2021/07/06 06:00 [pubmed]
PHST- 2021/07/06 06:01 [medline]
PHST- 2021/03/01 00:00 [pmc-release]
AID - 10.26574/maedica.2020.16.1.6 [doi]
PST - ppublish
SO  - Maedica (Bucur). 2021 Mar;16(1):6-15. doi: 10.26574/maedica.2020.16.1.6.