Antithrombotic treatment in real-life atrial fibrillation patients: a report from the Euro Heart Survey on Atrial Fibrillation

Nieuwlaat, Robby; Capucci, Alessandro; Lip, Gregory Y.H.; Olsson, S. Bertil; Prins, Martin H.; Nieman, Fred; López‐Sendón, José; Vardas, Panos; Aliot, Étienne; Santini, Massimo; Crijns, Harry J.G.M.

doi:10.1093/eurheartj/ehl015

Cited by 338 publications

(230 citation statements)

References 38 publications

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“…A lack of knowledge of, or the noncompliance to therapeutic guidelines on stroke prophylaxis management and the overestimation of the bleeding risk associated with warfarin therapy, may prevent physicians from prescribing warfarin for AF patients, as reflected by different studies. 7,11,14,15 Patients' knowledge of AF and warfarin can affect their utilization of warfarin. A deficiency in understanding of their own disease and warfarin may mean that the patients do not know the necessity of treatment, which may lead to noncompliance of warfarin therapy, and in turn influence both physicians' and patients' preference on antithrombotic agent for stroke prevention therapy.…”

Section: Discussionmentioning

confidence: 99%

Barriers to Warfarin Use for Stroke Prevention in Patients With Atrial Fibrillation in Hong Kong

Lee

Tam

Yan

et al. 2012

Clinical Cardiology

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Background:Oral anticoagulation medications such as warfarin reduce the risk of stroke in atrial fibrillation (AF) but have been underutilized. This study aimed to investigate physicians' perceptions of stroke prevention management and patients' knowledge of AF and warfarin therapy in Hong Kong (HK).Hypothesis:Both physician and patient's knowledge on warfarin use were the barriers for stroke prevention in patients with atrial fibrillation in Hong Kong.Methods:This prospective survey‐based study was conducted between February 2011 and April 2011 to assess physicians' perceptions of stroke prevention management, patients' knowledge of AF, and patients' knowledge of warfarin therapy. The results were scored and compared with those in foreign countries.Results:Sixty‐two physicians and 114 warfarin users were recruited in the study. The average score of HK physicians in the knowledge of stroke prevention therapy in AF patients was lower than that of Australian (AUS) family physicians (HK 2.48 vs AUS 4.02 out of 7). The mean scores of AF patients in Hong Kong regarding the knowledge of AF were lower than that of United Kingdom (UK) (HK 1.16 vs UK 2.24 out of 4) (P < 0.001) and that of Finland (FIN) (HK 2.77 vs FIN 5.94 out of 8) (P < 0.001), respectively. The mean score of AF patients in Hong Kong regarding the knowledge of warfarin therapy was lower than that of AF patients in the United States (US) (HK 2.39 vs US 3.92).Conclusions:The barriers of warfarin use for AF patients in Hong Kong were related to both physicians and patients. Many Hong Kong physicians did not comply with international recommendations of stroke prevention in AF patients, and AF patients had a low knowledge level about the disease and warfarin therapy.Presented at the International Congress of Cardiology, Hong Kong, Peoples Republic of China, February 24‐26, 2012.This study was supported by the School of Pharmacy, the Chinese University of Hong Kong.The authors have no other funding, financial relationships, or conflicts of interest to disclose.

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Section: Discussionmentioning

confidence: 99%

Barriers to Warfarin Use for Stroke Prevention in Patients With Atrial Fibrillation in Hong Kong

Lee

Tam

Yan

et al. 2012

Clinical Cardiology

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“…En un estudio europeo Nieuwlaat et al, encontraron que sólo el 67% de pacientes con indicación de ACO estaba recibiendo tratamiento (11). Los ensayos clínicos estiman que el promedio de los pacientes puede mantener un rango de INR entre 2-3 durante el 60-65% del tiempo (5).…”

Section: Introductionunclassified

Factores asociados a la anticoagulación oral óptima en el adulto mayor con fibrilación auricular

et al. 2017

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RESUMENObjetivos: Determinar la calidad del control de la anticoagulación oral y los posibles factores asociados al tiempo de rango terapéutico. Material y métodos: Estudio retrospectivo con grupo control y exploración de posibles variables, realizado en pacientes ≥65 años con fibrilación no valvular e indicación de anticoagulación del Hospital Cayetano Heredia entre el 2011-2013. Se determinó el tiempo de rango terapéutico (TRT) por el método de Rosendaal y se consideró control óptimo (TRT ≥60%) y subóptimo (TRT <60%). Se realizó análisis univariado para los factores. Resultados: La mediana de la edad fue 82,23 años, 74 (51,75%) fueron mujeres. Ciento cuarenta pacientes tuvieron indicación de anticoagulación, 94 (67,14%) iniciaron warfarina, 28 (19,72%) tuvo control óptimo y 66 (46,48%) subóptimo. La edad ≥75 años (OR 25,5; IC: 7,8), no bajo grado de instrucción (OR 8; IC 3,61), ≥3 comorbilidades (OR 4,5; IC 2,33-9,39), discontinuidad terapéutica (OR 2,75; IC 1,44-5,52) y polifarmacia (OR 4,2; IC 2,16-8,80) se asociaron con control subóptimo, mientras que independencia funcional (OR 4,3; IC 2,16-9,47), no deterioro cognitivo (OR 7,8; IC 3,19) y género femenino (OR 3; IC 1,62-5,81) al control óptimo. Conclusiones: Un gran porcentaje de pacientes con indicación de ACO y con bajo riesgo de sangrado no iniciaron terapia anticoagulante; y el 50% de quienes la iniciaron, tuvo un control subóptimo. Los pacientes de mayor edad, con mayor comorbilidad y el uso de múltiples medicamentos se asociaron con control subóptimo; mientras que el género femenino y la independencia funcional se asociaron con control óptimo.PALABRAS CLAVE: Fibrilación atrial, warfarina, anciano, accidente cerebrovascular. (Fuente: DeCS BIREME). SUMMARY Objective:To determine the quality of oral anticoagulation control and the possible factors associated with time to reach therapeutic range. Methods: Retrospective study with a control group in patients ≥65 years old with nonvalvular atrial fibrillation who had indication for oral anticoagulation at Hospital Cayetano Heredia from 2011 to 2013. Time to therapeutic range (TTR) was determined by the Rosendal´s method, an optimal control was defined as TTR ≥60%. A multivariate analysis was performed. Results: Median age was 82.23 years; 74 (51.75%) were females; 140 patients had indication for anticoagulation; 94 (67.14%) started warfarin; 28 (19.72%) had optimal control and 66 did not (46.48%). Age ≥ 75 years (OR 25.5; and no low degree of instruction (OR

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“…The need for routine coagulation monitoring and dose adjustment may contribute to inadequate VKA use in real-world practice, particularly where access to international normalized ratio (INR) monitoring services is limited. 12 This article discusses recent developments that may lead to improved patient outcomes and quality of life in the near future. These include advances in stroke and bleeding risk stratification and selection of patients who may benefit from OAC therapy, and the emergence of newer OACs with improved benefit-risk profiles (vs VKAs), which can be given at fixed doses without routine coagulation monitoring.…”

Section: Introductionmentioning

confidence: 99%

Advances in Stroke Prevention in Atrial Fibrillation: Enhanced Risk Stratification Combined With the Newer Oral Anticoagulants

Verheugt

2013

Clinical Cardiology

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Patients with atrial fibrillation (AF) have an increased stroke risk compared with those in sinus rhythm, although the absolute risk for individual patients is modulated by the presence of various additional risk factors. Patient selection for oral anticoagulation for stroke prevention is based on risks of stroke and bleeding. Although CHADS 2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack) is the most widely used scheme for evaluating stroke risk in patients with AF, several other stroke risk factors are not included; therefore, many patients' stroke risk may be underestimated, contributing to the underuse of anticoagulants. Furthermore, a substantial proportion of patients are categorized as being at moderate risk (CHADS 2 = 1), and there has been some ambiguity regarding optimum thromboprophylaxis in this group. -VASc = 0), who are unlikely to benefit from antithrombotic therapy. For all others, an oral anticoagulant may be the preferred approach, simplifying clinical decision making. Implementation of CHA 2 DS 2 -VASc may also result in an increased proportion of patients receiving anticoagulation. The emergence of newer oral anticoagulants that can be given without routine coagulation monitoring, with improved benefit-risk profiles vs vitamin K antagonists, promises to simplify therapy for patients with AF at risk of stroke. This, coupled with advances in stroke risk stratification, is expected to improve patient outcomes and reduce the burden of AF-related stroke. IntroductionAtrial fibrillation (AF) is the most frequent clinically relevant cardiac arrhythmia encountered in the outpatient clinic, 1 affecting ∼ 1% of the US population and up to 10% of individuals age ≥80 years, with a higher prevalence among men than among women at all ages. 2 It is predicted that the prevalence of AF will continue to rise in the coming decades. 3 Patients with AF are at an increased risk of cardioembolic stroke; their risk is approximately 5-fold greater than for patients in sinus rhythm, 4 although the absolute risk for individual patients is highly variable depending on the presence or absence of various risk factors. 5,6

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Antithrombotic treatment in real-life atrial fibrillation patients: a report from the Euro Heart Survey on Atrial Fibrillation

Cited by 338 publications

References 38 publications

Barriers to Warfarin Use for Stroke Prevention in Patients With Atrial Fibrillation in Hong Kong

Barriers to Warfarin Use for Stroke Prevention in Patients With Atrial Fibrillation in Hong Kong

Factores asociados a la anticoagulación oral óptima en el adulto mayor con fibrilación auricular

Advances in Stroke Prevention in Atrial Fibrillation: Enhanced Risk Stratification Combined With the Newer Oral Anticoagulants

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