Current anticoagulant usage patterns and determinants in Korean patients with nonvalvular atrial fibrillation

Hyun Su Ha, Joongmin Kim, Young Soo Lee, Tae Hoon Kim, Jung Myung Lee, Junbeom Park, Jin Kyu Park, Ki Woon Kang, Jaemin Shim, Jae Sun Uhm, Hyung Wook Park, Myung Jin Cha, Eue Keun Choi, Jun Kim, Jin Bae Kim, Changsoo Kim, Boyoung Joung

    Research output: Contribution to journalArticlepeer-review

    1 Citation (Scopus)


    Purpose: Stroke prevention in patients with atrial fibrillation (AF) is influenced by many factors. Using a contemporary registry, we evaluated variables associated with the use of warfarin or direct oral anticoagulants (OACs). Materials and Methods: In the prospective multicenter CODE-AF registry, 10529 patients with AF were evaluated. Multivariate analyses were performed to identify variables associated with the use of anticoagulants. Results: The mean age of the patients was 66.9±14.4 years, and 64.9% were men. The mean CHA2DS2-VASc and HAS-BLED scores were 2.6±1.7 and 1.8±1.1, respectively. In patients with high stroke risk (CHA2DS2-VASc ≥2), OACs were used in 83.2%, including direct OAC in 68.8%. The most important factors for non-OAC treatment were end-stage renal disease [odds ratio (OR) 0.27; 95% confidence interval (CI): 0.19–0.40], myocardial infarct (OR 0.53; 95% CI: 0.40–0.72), and major bleeding (OR 0.57; 95% CI: 0.39– 0.84). Female sex (OR 1.40; 95% CI: 1.21–1.61), cancer (OR 1.78; 95% CI: 1.38–2.29), and smoking (OR 1.60; 95% CI: 1.15–2.24) were factors favoring direct OAC use over warfarin. Among patients receiving OACs, the rate of combined antiplatelet agents was 7.8%. However, 73.6% of patients did not have any indication for a combination of antiplatelet agents. Conclusion: Renal disease and history of valvular heart disease were associated with warfarin use, while cancer and smoking status were associated with direct OAC use in high stroke risk patients. The combination of antiplatelet agents with OAC was prescribed in 73.6% of patients without definite indications recommended by guidelines.

    Original languageEnglish
    Pages (from-to)120-128
    Number of pages9
    JournalYonsei medical journal
    Issue number2
    Publication statusPublished - 2020 Feb

    Bibliographical note

    Funding Information:
    This study was supported by a research grant from the Korean Healthcare Technology R&D Project funded by the Ministry of Health & Welfare (HI15C1200).

    Publisher Copyright:
    © Yonsei University College of Medicine 2020.


    • Anticoagulation
    • Atrial fibrillation
    • Determinant
    • Pattern

    ASJC Scopus subject areas

    • General Medicine


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