OBJECTIVES: This study was aimed to examine the clinical characteristics of patients with non-valvular atrial fibrillation (NVAF) treated with apixaban in a real world setting.

METHODS: In this multi-center, retrospective, observational study, we collected data from 5 hospital databases (North, Center and South Italy) on consecutive patients with a diagnosis of NVAF who had initiated apixaban from 1 January 2014 up to 31 March 2016. Protocol and Case Report Form were submitted and approved by Ethic Committees; patient anonymized data were uploaded by clinicians; statistical analyses were performed by University of Milan-Bicocca.

RESULTS: Data from 766 patients affected by NVAF from five Italian Centers were analyzed. The mean age was 74.2 years, 53.5% of patients were women and the median CHADS and CHADSVASc scores were respectively 2.0 and 4.0. The most frequent co-morbidities were cardiovascular diseases (hypertension [84%]; previous vascular disease [34%]; heart failure [22%]), renal impairment [34%], diabetes mellitus [22%] and anemia [12%]). In the whole cohort, half patients (50.7%) were naïve to oral anticoagulants, while 219 patients had been previously treated with warfarin, 66 with heparin, 52 with acetylsalicylic acid, 1 with clopidogrel and 40 with a novel oral anticoagulant (NOAC). At treatment initiation, 76.5% of patients was prescribed apixaban at the recommended daily dose of 10 mg, while the remaining patients (23.5%) received the reduced daily dose of 5 mg. During the follow-up period, apixaban dose was reduced only in 2.0% of patients at V1, in 3.2% at V2 and in 4.8% at V3. Switching to another anticoagulant occurred in 5.3% of patients at V1, in 8.3% at V2 and in 9.5% at V3.

CONCLUSIONS: Patient characteristics observed in this study were very similar compared to clinical trials population, while the use of the reduced daily dose of 5 mg seemed to be higher in real life.