Management of anticoagulation in atrial fibrillation patients in Italy: insight from the Atrial Fibrillation-Survey on Anticoagulated Patients Register (AF-START)

Submitted: 14 May 2023
Accepted: 22 June 2023
Published: 27 June 2023
Abstract Views: 779
PDF: 165
Supplementary File: 59
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  • Daniela Poli Center of Atherothrombotic Disease, Careggi University Hospital, Florence, Italy.
  • Walter Ageno Short Stay Observation and Short Recovery Unit, Department of Internal Medicine, Circolo Hospital and Macchi Foundation, ASST Sette Laghi, Varese, Italy.
  • Emilia Antonucci Arianna Anticoagulazione Foundation, Bologna, Italy.
  • Salvatore Bradamante Transfusion Center, Hemostasis and Thrombosis Center, Annunziata Hospital, Taranto, Italy.
  • Eugenio Bucherini Vascular Medicine and Angiology SS, AUSL Romagna, Ravenna, Italy.
  • Paolo Chiarugi Clinical Chemical Analysis Organizational Unit, Pisana University Hospital, Pisa, Italy.
  • Antonio Chistolini Department of Translational and Precision Medicine, Sapienza University of Rome, Italy.
  • Benilde Cosmi Division of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, Bologna, Italy.
  • Anna Falanga Thrombosis, Hemostasis Immunohematology and Transfusion Medicine Center, ASST Papa Giovanni XXIII, Bergamo, Italy.
  • Antonio Insana SC Chemical-Clinical Analysis and Microbiology Laboratory, Ordine Mauriziano Hospital, Turin, Italy.
  • Domenico Lione Complex Operating Unit of Clinical Pathology, A. Perrino Hospital, Brindisi, Italy.
  • Rosa Maria Lombardi Internal Medicine Organization Unit, Hemostasis and Thrombosis Center, University Hospital of Parma, Italy.
  • Giuseppe Malcangi Hemophilia and Thrombosis Center, Polyclinic of Bari, Italy.
  • Rossella Marcucci Center of Atherothrombotic Disease, Careggi University Hospital, Florence, Italy.
  • Giuliana Martini Hemostasis Center, Civilian Hospitals of Brescia, Italy.
  • Lucilla Masciocco Complex Operating Unit of Internal Medicine, Lastaria Hospital, Lucera (FG), Italy.
  • Carmelo Paparo Analysis Laboratory, Maggiore Chieri Hospital, Turin, Italy.
  • Daniele Pastori Department of Clinical Internal Medicine, Anesthesiology and Cardiovascular Sciences, Thrombosis Center, Sapienza University of Rome, Italy.
  • Simona Pedrini Laboratory Service, Poliambulanza Foundation Hospital, Brescia, Italy.
  • Vittorio Pengo Department of Cardio-Thoracic-Vascular Sciences, University Hospital of Padua, Italy.
  • Pasquale Pignatelli Department of Clinical Internal Medicine, Anesthesiology and Cardiovascular Sciences, Thrombosis Center, Sapienza University of Rome, Italy.
  • Andrea Toma Complex Operating Unit of Clinical Pathology, Oral Anticoagulant Therapy Outpatient Clinic, L. Cazzavillan Civilian Hospital, Arzignano (VI), Italy.
  • Sophie Testa Department of Laboratory Medicine, Hemostasis and Thrombosis Center, ASST Cremona, Italy.
  • Gualtiero Palareti Arianna Anticoagulazione Foundation, Bologna, Italy.

The survey on anticoagulated patients register (START-Register) is an independent, prospective, inception-cohort observational study aimed at providing information on patients on vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) in Italy. In this study, we describe the cohort of atrial fibrillation (AF) patients in the START-Register and report outcomes and changes in anticoagulant prescription from 2011 to 2021. The study included 11,078 AF patients, enrolled in 47 Italian centers distributed all over the Country; the median age was 77 years (range 18-99 years); 6029 (54.3%) were men; 5135 (46.4%) were on VKAs, and 5943 (53.6%) were on DOACs. Warfarin was the most prescribed VKA (98.4%), and apixaban was the most prescribed DOAC (31.6%). Among DOAC users, 4022 (67.7%) patients were naive to anticoagulation, and 2562 (43.1%) patients were treated with a reduced dose. DOAC patients were significantly older than VKA patients (median age 79 years vs 76 years respectively, P<0.001), but no gender difference was detected. The mean CHA2DS2VASc score was higher in DOAC users than in VKA users (3.7 vs 3.6; P=0.03). The mean HAS-BLED score was not different between the two groups. During follow-up, 542 bleeding events were recorded [2.44 per 100 patient-years (pt-yrs)]; 240 were major (1.08 per 100 pt-yrs), and 301 were clinically relevant non-major bleedings (1.34 per 100 pt-yrs). 146 thrombotic events were recorded during follow-up (0.66 per 100 pt-yrs). The total mortality rate was 3.5 per 100 pt-yrs; the mortality rate was 4.54 per 100 pt-yrs among patients on VKAs and 2.31 per 100 pt-yrs among patients on DOACs. During the last 10 years, in Italy, AF patient management has changed with the large spread of DOACs all over the Country. DOAC patients are frequently treated with reduced doses and show a lower mortality rate in comparison to patients on VKAs.



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How to Cite

Poli, D., Ageno, W., Antonucci, E., Bradamante, S., Bucherini, E., Chiarugi, P., … Palareti, G. (2023). Management of anticoagulation in atrial fibrillation patients in Italy: insight from the <i>Atrial Fibrillation-Survey on Anticoagulated Patients Register</i> (AF-START). Bleeding, Thrombosis and Vascular Biology, 2(2).