IJCS | Volume 33, Nº1, January / February 2019

69 Geraldes et al. Oral anticoagulation in AF Int J Cardiovasc Sci. 2020;33(1):68-78 Original Article do not require laboratory monitoring to determine effective therapeutic level and have few significant drug interactions. The purpose of this study is to determine the pattern and predictors of the use of anticoagulants in eligible patients with AF and how fast DOACs are incorporated in this context. Methods Reference population Data were collected from an electronic medical record of all hospitalized patients diagnosed with AF and/or atrial flutter at a private tertiary institution in Salvador, Bahia, fromMay 23, 2011 (date of approval of dabigatran in Brazil) to June 30, 2016. Patients were screened from ICDs I48 and R00, and only those with documented AF or atrial flutter were recruited. Study design Retrospective observational study based on electronic chart review, with annual cross-sections for five consecutive years (trends study). Inclusion and exclusion criteria Inclusion criteria were: age ≥ 18 years, AF diagnosis and/or atrial flutter confirmed by ECG and/or Holter. Patients without electronic prescription of discharge were excluded, as this was the source of the data regarding the use of anticoagulant. On readmissions, the most recent admission was chosen for analysis. Data collected and definitions Demographic and anthropometric datawere collected, in addition to the cardiovascular risk factors traditionally related to AF (systemic arterial hypertension [SAH], diabetes, valve disease, myocardial infarction, heart failure, history of bleeding, medications). The risk scores for stroke and bleeding were CHA 2 DS 2 VASc and HASBLED, validated in international studies. 12-14 AF was classified according to the II Brazilian Guidelines for Atrial Fibrillation of the Brazilian Society of Cardiology. 15 When therewas insufficient information for classification, AF was considered of indefinite duration. Prior AF was defined as the identification of episodes of this arrhythmia prior to the reference admission during review of medical records. Echocardiographic data were collected from the most recent test, respecting the period of up to 1 year before admission. Valvular heart disease was defined as the presence of any moderate or severe mitral or aortic lesion. The presence of a valve prosthesis was defined by echocardiogram or clinical history. Electronic prescription of discharge was used to collect information on anticoagulants, antiplatelets and their doses, and other drugs with potential for drug interaction. All information regarding hemorrhagic events was collected, but only major bleeding — intracranial hemorrhage, need for blood products or corrective surgical treatment — were considered for analysis. Thefollowingwereconsideredabsolutecontraindications for oral anticoagulants: active bleeding, severe hemorrhagic diathesis, thrombocytopenia < 50,000, invasive surgery or procedure to be done, major trauma, hemorrhagic stroke, intracranial or spinal tumor, spinal anesthesia, uncontrolled SAH. Relative contraindications included: end-stage neoplasia, active peptic ulcer, advanceddementia (without a caregiver), alcoholismand frequent falls (more than three per year). Patients with zero CHA 2 DS 2 -VASc were not considered candidates for anticoagulation. Inappropriate use of DOAC 16 was defined as follows: prescriptions containing drugs with strong drug interaction potential; dose inconsistent with the dosage recommended by themanufacturer, considering patient’s age, weight and renal function; presence of absolute contraindications (mechanical cardiac valve prosthesis or moderate to severe mitral stenosis). Statistical analysis Continuous variables were summarized by mean and standard deviation or median and interquartile distance, as indicated by the frequency distribution. Comparisons of quantitative variables between 2 groups were done using Student’s t test for independent samples and Mann-Whitney. Categorical variables were summarized using simple and relative frequencies, compared between groups using the chi-square test. For analysis of correlation between the HASBLED and CHA 2 DS 2 -VASc scores, the Spearman’s technique was used. To identify predictors of anticoagulation and anticoagulant type, we used binary logistic regression. Firstly, we made a selection of variables using univariate logistic regression. The variables associated with anticoagulation and use of DOAC with p value < 0.05 in