Rate and Reasons for the Use of Oral Anticoagulants in
Patients with Non-Valvular Atrial Fibrillation and a
CHA₂DS₂-VASc Score of 0 in Thailand: The COOL-AF Registry
Komsing Methavigul, MD¹, Arjbordin Winijkul, MD², Sirin Apiyasawat, MD³, Ratikorn Methavigul, MD¹,
Thanasak Patmuk, MD⁴, Pattraporn Srirattana, MD⁵, Praprut Thanakitcharu, MD⁶, Kulyot Jongpiputvanich, MD⁷,
Sumon Tangsuntornwiwat, MD⁸, Ahthit Yindeengam, BSc², Rungroj Krittayaphong, MD², for the COOL-AF Investigators
Affiliation : ¹ Department of Cardiology, Central Chest Institute of Thailand, Nonthaburi, Thailand ² Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ³ Division of Cardiology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ⁴ Ratchaburi Hospital, Ratchaburi, Thailand ⁵ Charoen Krung Pracha Rak Hospital, Bangkok, Thailand ⁶ Sapphasitthiprasong Hospital, Ubon Ratchathani, Thailand ⁷ Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand ⁸ Udon Thani Hospital, Udon Thani, Thailand
Background: A substantial number of patients with non-valvular atrial fibrillation (NVAF) and a CHA₂DS₂-VASc score of 0 (i.e., low-risk
group) use oral anticoagulants (OACs).
Objective: To investigate the rate and reasons for OAC use in Thai patients with NVAF and having a CHA₂DS₂-VASc score of 0.
Materials and Methods: A nationwide observational multicenter registry of patients with NVAF was set up in Thailand. The patients’ demographic and clinical data were recorded on a case record form and then entered into a web-based data collection and management system.
Results: One hundred seventy-six patients with NVAF and a CHA₂DS₂-VASc score of 0 were included. The average age was 53.9±8.2 years old, and all patients were male. Forty-six (26.1%) of the patients received OACs. NVAF patients receiving OACs had a longer duration of AF, more persistent and permanent AF, and mild left ventricular dysfunction. NVAF patients not receiving OACs were significantly more likely to be taking antiplatelet drugs. The reasons for using OACs in patients with a CHA₂DS₂-VASc score of 0 included thrombus in the left atrial appendage, post-AF ablation, planned cardioversion, hypertrophic cardiomyopathy, hyperthyroidism, and endomyocardial fibrosis. Physicians or patients preferred OAC use despite having a CHA₂DS₂-VASc score of 0 in 24 patients (52.2%). The use of OACs did not decrease clinical events, but it increased the bleeding risk.
Conclusion: Among Thai NVAF patients with CHA₂DS₂-VASc score of 0, OAC was used in 26.1%. Some stroke risk factors were identified but were not included in the current risk scoring tool.
Received 8 June 2020 | Revised 6 July 2020 | Accepted 10 July 2020
doi.org/10.35755/jmedassocthai.2020.10.11529
Keywords : Oral anticoagulant, Outcomes, Non-valvular atrial fibrillation, CHA₂DS₂-VASc score, Thailand
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