Anticoagulation Therapy by Age and Embolic Risk for Nonvalvular Atrial Fibrillation in Mexico, an Upper-Middle-Income Country: The CARMEN-AF Registry

Manlio F. Márquez(Instituto Nacional de Cardiologia), Manuel Alfonso Baños‐González(Universidad Juárez Autónoma de Tabasco), Milton E Guevara-Valdivia(Mexican Social Security Institute), Jorge A. Vázquez-Acosta(Pemex (Mexico)), Manuel Odin de Los Rios Ibarra(Centro de Investigación y Desarrollo), Julio A. Aguilar-Linares(Mexican Social Security Institute), Marcelo Jiménez-Cruz(Mexican Social Security Institute), Norberto Matadamas-Hernández(Acapulco Institute of Technology), Rocío Camacho-Casillas(Mexican Social Security Institute), Reynaldo Magaña-Magaña(Martinez VA Medical Center), Ulises Rojel-Martínez(Hospital General de México), Marco A. Alcocer‐Gamba(Instituto Tecnológico de Querétaro), Susano Lara-Vaca(Hospital de León), Humberto Rodríguez-Reyes(Sociedad Española de Cardiología), Marco A. Islava-Gálvez(Mexican Institute of Petroleum), Lidia E. Betancourt-Hernández(Mexican Social Security Institute), Nicolás Reyes-Reyes(Coxa Hospital), Miguel E. Beltrán-Gámez(Universidad de Tijuana), Carlos Cantú‐Brito(Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán), Alberto Z. Baños-Velasco(Universidad Católica de Culiacán), Pedro J. del Rivero Morfin(Instituto Nacional de Cardiologia), Jesús Antonio González-Hermosillo(Instituto Nacional de Cardiologia)
Global Heart
April 10, 2020
10.5334/gh.767
Cited by 7Open Access
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Abstract

<strong>Background:</strong> Documenting the patterns of oral anticoagulation therapy (OAT) is essential to prevent thromboembolic complications of nonvalvular atrial fibrillation (NVAF). <strong>Objective:</strong> To report the patterns of OAT according to age and thromboembolic risk in patients included in CARMEN-AF, a nationwide registry of NVAF in Mexico, an upper middle-income country. <strong>Material and methods:</strong> There were 1,423 consecutive patients =18 years old and with at least one thromboembolic risk factor enrolled in the CARMEN-AF Registry at their regular clinical visit during a three-year period. They were analyzed according to 1) age, 2) AF type, and 3) CHA<sub>2</sub>DS<sub>2</sub>-VASc score. <strong>Results:</strong> Overall, 16.4% of patients did not receive antithrombotic treatment, 19.4% received antiplatelet drugs (APD), 29.2% vitamin K antagonists (VKA), and 34.6% direct oral anticoagulants (DOAC). With increasing age, the proportion of subjects treated with VKA decreased significantly from 36.2% in subjects 2DS<sub>2</sub>-VASc =2) compared with the moderate risk group (41% in CHA<sub>2</sub>DS<sub>2</sub>-VASc = 1). <strong>Conclusions:</strong> VKA use for NVAF in Mexico decreased in relation to increasing age. The proportion of DOAC therapy was the same in all age groups. Nevertheless, elderly patients with high thromboembolic risk received a suboptimal thromboprophylaxis. These data could help to improve gaps in the implementation of global guidelines. <strong>Clinical trial registration:</strong> <a href="http://www.clinicaltrials.gov" target="_blank">http://www.clinicaltrials.gov</a>. Unique identifier: NCT02334852. <strong>Highlights:</strong> <ul><li>CARMEN-AF is a nationwide multi-centric registry seeking to bridge the data gap on anticoagulation therapy for NVAF in Mexico.</li><li>Elderly patients are more prone to receive suboptimal OAT for NVAF.</li><li>DOAC were less frequently used in high thromboembolic risk patients (CHA<sub>2</sub>DS<sub>2</sub>-VASc =2).</li></ul>

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