Anticoagulação oral em pacientes com fibrilação atrial: das diretrizes à prática clínica

Abstract

Objective. Although oral anticoagulation (OAC) has proved beneficial for patients with atrial fibrillation (AF) and embolic risk factors, it is still underused. The objective of this study was to evaluate the adequacy of anticoagulation therapy in patients with AF followed up in a private clinic specialized in cardiology, in accordance with the American and European societies of cardiology guidelines/2006 and with the Sociedade Brasileira de Cardiologia (Brazilian Society of Cardiology -SBC) guidelines/2003. MethOds. Between November 2005 and August 2006, 7,486 electrocardiograms were evaluated and 53 patients with AF diagnosis and complete detailed information in medical records on embolic risk factors and oral anticoagulation treatment were selected. Results. Among the 53 patients included (68±16 years; 29 men -55%), 25 (48%) had hypertension, 20 (38%) heart failure and 3 (6%) diabetes mellitus. Among the 15 patients with high embolic risk, 13 (86%) were using OAC. In accordance with the American and European guidelines: 32 (60%) patients were Class I, 17 (32%) Class IIa, 1 (2%) Class IIb and 3 (6%) Class III. Treatment was adequate in 21 (66%) Class I patients and 13 (76%) Class IIa. In this subgroup, anticoagulation therapy was being used in 7/19 (37%) patients ≥ 75 years compared to 22/30 (73%) younger (p=0.016). Among the 3 patients within Class III, 1 was incorrectly on OAC. According to Brazilian guidelines, 33 (62%) were on correctly indicated antithrombotic therapy. There was no difference in the appropriate prescription of oral anticoagulants, comparing Brazilian and American/European guidelines (55% vs. 55%). cOnclusiOn. Anticoagulant therapy is being adequately prescribed for the majority of AF patients, although this index is still far from ideal, especially in a cardiology clinic. This is even more critical in the group of elder patients.

A survey of recently published cardiovascular, hematological and pneumological original articles in the Brazilian scientific press

“…Ammirati et al54 used epoetin to correct anemia and found a decrease in morbidity and increases survival and quality of life in end-stage renal disease. Macedo et al55 evaluated the adequacy of anticoagulation therapy in patients with atrial fibrillation followed in a private clinic specialized in cardiology, in accordance with the American and European societies of cardiology guidelines/2006 and with the Brazilian Guidelines/2003. They conclude that anticoagulant therapy has been adequately prescribed for the majority of patients, although still far from ideal, especially in a cardiology clinic.…”

Stroke Prevention in Atrial Fibrillation: Focus on Latin America

“…65 A review of prescribing habits in a Brazilian cardiology department found that anticoagulant use according to the Brazilian guidelines was 55%, which was consistent with international guidelines, while 86% of patients with a high risk of embolism were prescribed oral anticoagulants. 66 These statistics suggest that guidelines may not be adhered to strictly in practice, with a significant proportion of Latin American patients not receiving adequate anticoagulation.…”

Metabolic syndrome, atrial fibrillation, and stroke: Tackling an emerging epidemic

“…106 Concern on the part of both patients and physicians also means that a large proportion of patients who would stand to benefit from warfarin therapy are left untreated, or rather are treated with essentially ineffective anti-platelet drugs such as aspirin. 107 Suboptimal risk assessment and consequently under-treatment is a particular issue outside Europe and North America.…”

“…108 In Brazil, the proportion of patients with AF at risk of stroke receiving anticoagulation therapy may be as low as 24%. 106,109 In Mexico, only 24% of patients with AF who have suffered a stroke and 40% of patients of those who have suffered several strokes receive warfarin therapy. 110 These data are clearly of concern and account for a large proportion of preventable events in countries set to suffer the most from population ageing and the emerging metabolic syndrome epidemic.…”