IJCS | Volume 33, Nº1, January / February 2019

72 Chart 1 - Frequency of risk scores, CHA 2 DS 2 VASc and HASBLED in 377 patients admitted with atrial fibrillation at a tertiary hospital in Salvador, Bahia, Brazil. KVA DOAC Antiplatelet agent alone No medication HASBLED 15.4 4.8 64.4 15.4 25.2 20.7 15.2 11.1 61.2 47.8 30.3 22.2 7.9 22.8 39.4 56 5.8 8.7 15.2 100% 80% 60% 40% 20% 0% 0 1 2 3 4 Geraldes et al. Oral anticoagulation in AF Int J Cardiovasc Sci. 2020;33(1):68-78 Original Article was a strong correlation between the HASBLED and CHA 2 DS 2 -VASc scores (Spearman’s r 0.706). Predictors of use and type of anticoagulants Most patients who had anticoagulants prescribed on hospital discharge had a history of previous episodes of AF (p = 0.001) and TIA/stroke (p = 0.008), were older (p = 0.056), had lower meanHASBLED (p < 0.001), higher mean weight (p = 0.002) and higher prevalence of SAH (p = 0.052) than non-anticoagulated patients. In the multivariate logistic regression analysis, the following remained as independent predictors of anticoagulation: previous episodes of AF, SAH and HASBLED (p < 0.001) (Table 2). To identify variables associated with the prescription of a given class of anticoagulants, we built a multiple logistic regression model using DOAC as a dependent variable and paroxysmal AF, CHF, serum creatinine, left ventricular ejection fraction, LA diameter, biological valve prosthesis, moderate valvular heart disease and electrical or chemical CV as independent variables. The variables serum creatinine (p < 0.002), LA diameter (p = 0.003) and biological valve prosthesis (p = 0.007) were inversely associated with the prescription of a DOAC, that is, were predictors of VKA prescription (Table 3). Appropriateness of the use of anticoagulants Of the 93 patients with AF whose discharge prescriptions did not contain anticoagulants, 43 had legitimate reasons for doing so: 14 with zero CHA 2 DS 2 VASc, 16 with absolute contraindications and 13 with relative contraindications. In the other 50 patients (54%), no reasons were found for the non-prescription of anticoagulants (45 patients) or the reasons on recordwere inconsistent with the literature (5 patients) —“requested by the attending physician”; “already had an indication of using anticoagulants and the attending physician did not prescribe”; “has bronchiectasis and history of bleeding”; “due to the risks of anticoagulation”; “will have pacemaker implanted” (Table 4). Discussion This is the first Brazilian study to demonstrate an increase in the use of oral anticoagulants in patients with AF as a result of progressive incorporation of DOACs into clinical practice. Despite the high thromboembolic risk of the study population, one-quarter of patients with AF were discharged without anticoagulant prescription, confirming findings from contemporary international registries. However, over the study period