AI Insight
This observational study of 1,901 patients with non-valvular atrial fibrillation in Spanish primary care compared outcomes between vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). Patients receiving DOACs reported higher treatment satisfaction but paradoxically showed higher rates of stroke, ischemic stroke, and major bleeding compared to VKA users. The differences may be explained by variations in patient profiles, with VKA users being older with more comorbidities, and significantly longer treatment duration (7.6 vs 3.8 years).
Why it matters
The findings challenge assumptions that DOACs consistently outperform VKAs in real-world settings and highlight the importance of patient selection and treatment duration when comparing anticoagulation strategies. The results suggest that despite better patient satisfaction, DOAC use in routine practice may be associated with different risk profiles that require careful consideration in treatment decisions.
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⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Objectives: To assess how patients with non-valvular atrial fibrillation (NVAF) receiving oral anticoagulants are managed in routine primary care practice in Spain. Methods: This observational, descriptive study included patients with NVAF treated with oral anticoagulants for at least 6 months before enrolment and managed in primary care settings in Spain. The Barthel and ACTS questionnaires were administered to evaluate functional autonomy and treatment satisfaction, respectively. Results: A total of 1,901 patients were included: 428 received vitamin K antagonists (VKAs) and 1,473 direct oral anticoagulants (DOACs). Compared with patients receiving DOACs, those treated with VKAs were significantly older and had a higher prevalence of more hypertension. Mean treatment duration was 7.6 years for VKAs and 3.8 years for DOACs. Among patients receiving VKAs, 56.2% and 59.0% achieved good anticoagulation control according to the direct and Rosendaal methods, respectively. Patients in the DOAC group reported greater satisfaction across several domains, including perceived treatment benefits, lower impact on daily life, and overall positive treatment effect. Event incidence rates (per 1,000 person-years) were higher with DOACs than with VKAs for stroke (1.75; 95% CI 1.05-2.92), ischemic stroke (1.78; 95% CI 1.06-3.00), acute myocardial infarction (1.64; 95% CI 0.97-2.79), and major bleeding (3.68; 95% CI 1.81-7.46). Conclusions: In routine primary care practice in Spain, patient profiles and treatment duration varied by oral anticoagulant type. These differences may partly explain the higher rates of stroke and major bleeding observed with DOACs versus VKAs, despite greater treatment satisfaction among patients receiving DOACs.