Changes in prescribing antithrombotic therapy in patients with atrial fibrillation and myocardial infarction in 2016-2019

Переверзева, К. Г.; Якушин, С. С.; Якушина, М С; Ежова, А. В.; Bogdanovich, I. A.; Simková, L

doi:10.15829/1560-4071-2020-3908

Cited by 3 publications

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References 11 publications

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“…Pavlov” of the Ministry of Health of the Russian Federation on 10 December 2018 (protocol No. 5) [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

“…A total of 360 patients with MI and AF were included in the research: in 2016–2017, 104, and 2018–2019, 256 patients. We described these groups of patients in detail in a previously published paper [ 13 , 14 ]. We analyzed patients on the CHA 2 DS 2 -VASc scales (congestive heart failure, hypertension, age 75 and older, diabetes mellitus, stroke or transient ischemic attack, vascular diseases, age 65 to 74 years, women) and HAS-BLED (hypertension, impaired kidney/liver function, stroke, bleeding anamnesis or predisposition, labile international normalized ratio, old age, simultaneous drug/alcohol use) points [ 15 , 16 ].…”

Section: Methodsmentioning

confidence: 99%

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Changes in Antithrombotic Therapy Prescription in Patients with a Combination of Atrial Fibrillation and Myocardial Infarction in a Specialised Inpatient Department from 2016–2019 and Associations with Prognosis

Yakushin,

Pereverzeva

2023

Medicina

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Background and Objectives: The problem of treating patients with atrial fibrillation and myocardial infarction is relevant. The issue of optimal antithrombotic therapy in these patients has not been definitively resolved. This work analyzes the influence of clinical factors and treatment on the long-term prognosis of patients. Materials and Methods: The research included 360 patients with atrial fibrillation and myocardial infarction during 2016–2019. Results: The factors associated with fatal outcomes were age (hazard ratio (HR): 1.05; 95% confidence interval (CI): 1.03–1.07; p < 0.001); stroke (HR: 1.95; 95% CI: 1.27–3.00; p = 0.0002); glomerular filtration rate (HR: 0.988; 95% CI: 0.978–0.998; p = 0.03); left ventricular ejection fraction (HR: 0.975; 95% CI: 0.957–0.999; p = 0.007); and aspirin (HR: 0.48; 95% CI: 0.31–0.73; p < 0.001). The factors associated with the combined endpoint were chronic kidney disease (HR: 1.46; 95% CI: 1.01–2.10; p = 0.04); HAS-BLED (HR: 1.23; 95% CI: 1.06–1.43; p = 0.007); percutaneous coronary intervention (HR: 0.70; 95% CI: 0.51–0.96; p = 0.03); and aspirin (HR: 0.65; 95% CI: 0.44–0.97; p = 0.03). Conclusions: Double and triple antithrombotic therapy were not associated with outcomes. Aspirin improved the prognosis for survival and the combined endpoint.

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“…Pavlov” of the Ministry of Health of the Russian Federation on 10 December 2018 (protocol No. 5) [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Changes in Antithrombotic Therapy Prescription in Patients with a Combination of Atrial Fibrillation and Myocardial Infarction in a Specialised Inpatient Department from 2016–2019 and Associations with Prognosis

Yakushin,

Pereverzeva

2023

Medicina

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Dynamics of Prescribing Antithrombotic Therapy to Patients with Atrial Fibrillation Hospitalized for Myocardial Infarction in 2016–2021

Korshikova,

Pereverzeva,

Yakushin

2023

I.P. Pavlov Russian Medical Biological Herald

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INTRODUCTION: At present, the issue of optimal antithrombotic therapy (ATT) in patients with myocardial infarction (MI) and atrial fibrillation (AF) has not been finally resolved, it requires an individual approach and is of interest for study. AIM: To study the dynamics of prescribing ATT to patients with AF of non-valvular etiology hospitalized in cardiology hospital in 20162021 for MI. MATERIALS AND METHODS: The study included 599 patients with MI and AF: in 20162017 104 patients, in 20182019 256 patients, in 20202021 239 patients. The median and interquartile range of age of patients hospitalized in 20162017 were 70 (61.0; 78.0) years, in 20182019 71 (65.0; 79.3) years, in 20202021 72 (65.0; 80.0) years, p = 0.09. RESULTS: In 20162017, 76.9% of patients with MI and AF were prescribed double antiplatelet therapy (DAPT) from the first day of hospitalization; 16.3% of patients were prescribed therapy with oral anticoagulants (OACs), here, in 6.7% as part of triple ATT, in 8.7% as part of double ATT (OACs + antiplatelet agent), in 1.0% as monotherapy with OACs; in 3.8% monotherapy with an antiplatelet agent was prescribed; in 2.9% of cases ATT was not prescribed. In 20182019, DAPT was used in 37.9% of cases; therapy with OACs in 54.7% of cases: in 44.9% cases as part of triple ATT, in 9.8% as part of double therapy; in 7.4% of cases monotherapy with antiplatelet agent was prescribed. In 20202021, DAPT was prescribed in 15.9% of cases; therapy with OACs in 74.5%, of them in 59.8% triple АТТ, in 14.2% double АТТ; monotherapy with an antiplatelet agent - in 7.5%; in 1.7% АТТ was not prescribed. CONCLUSION: In the study, the frequency of prescription of triple ATT to patients with AF and MI in 20202021 increased 1.3 times as compared to 20182019, and 8.9 times as compared to 20162017 and made 59.8% (p 0.001 for all periods). The frequency of OAC also increased 1.3 times as compared to 20182019 and 4.6 times as compared to 20162017 and made 74.5% (p 0.001 for all periods). This dynamics of increase in the frequency of prescription of oral anticoagulants to patients with a combination of AF and MI should be considered a positive result of introduction of the Clinical recommendations in the treatment of cardiologic patients.

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The influence of clinical and medical history factors and anti-thrombotic therapy on the prognosis in patients with atrial fibrillation and myocardial infarction

Переверзева

Agaltsova²,

Tishkina³

et al. 2022

Almanac of Clinical Medicine

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Aim: To assess an impact of clinical and medical history factors and antithrombotic therapy on the prognosis in patients with non-valvular atrial fibrillation (AF) admitted to the cardiology in-patient clinic for myocardial infarction (MI). Materials and methods: This was a retro-prospective study. Two hundred and fifty six (256) patients with AF plus MI (median age 71.0 [65.0; 79.3] years; men, 143 (55.8%)) were included into the retrospective part of the study in 20182019. Data on their clinical and medical history particulars, as well as on antithrombotic therapy were collected from their medical files. Nineteen (19) [13; 25] months after the index event (MI), telephone contact was made with patients or their relatives in order to assess the patient's life status, as well as record the frequency of non-fatal MI and cerebral strokes (MI). Contact was established with 253 patients. The completeness of the sample coverage is 99.0%. Results: During the follow-up after discharge from the hospital, 29.6% (n = 75) of patients died, 40.7% (n = 103) of patients reached the composite endpoint (CЕ), which included deaths, non-fatal MI and brain strokes. The patients who died, compared to those who survived, were older (77.0 [62.0; 82.0] vs 68.0 [62.0;76.7] years, respectively, p 0.001), with a smaller proportion of men (44.0% vs 61.2%, respectively, p = 0.012). They were also more likely to have had type 2 diabetes mellitus (50.7% vs 37.1%, p = 0.04) and the history of acute stroke (24.0% vs 8.4%, p 0.001), and less likely to have had percutaneous coronary intervention (48.0% vs 64.0%, p 0.001). Serum creatinine levels in those who have died were higher than in the surviving patients (114.0 [95.0; 139.0] mmol/l vs 99.5 [85.0; 120.0] mmol/l, p 0.001). The patients who have achieved CE, compared to those who have not, were older (75.0 [67.0; 81.0] vs 65.0 [50.0; 82.0] years, respectively, p 0.001), with a smaller proportion of men (48.5% vs 61.3%, respectively, p = 0.045), higher proportion of patients with past history of stroke (20.4% vs 8.0%, p = 0.005) and fewer patients who had underwent percutaneous coronary intervention (52.4% vs 66.0%, p 0.03). There was no significant association between the administration of anti-platelet agents and/or oral anticoagulants and outcomes in the patients with AF and MI. Conclusion: In the patients with AF and MI, a higher death risk and achievement of CE were significantly associated with age and a history of stroke. The use of anti-platelet agents and oral anticoagulants in various combinations had no significant impact on the outcomes in this patient group, which is likely related to small duration of the follow-up and small patient sample.

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Changes in prescribing antithrombotic therapy in patients with atrial fibrillation and myocardial infarction in 2016-2019

Cited by 3 publications

References 11 publications

Changes in Antithrombotic Therapy Prescription in Patients with a Combination of Atrial Fibrillation and Myocardial Infarction in a Specialised Inpatient Department from 2016–2019 and Associations with Prognosis

Changes in Antithrombotic Therapy Prescription in Patients with a Combination of Atrial Fibrillation and Myocardial Infarction in a Specialised Inpatient Department from 2016–2019 and Associations with Prognosis

Dynamics of Prescribing Antithrombotic Therapy to Patients with Atrial Fibrillation Hospitalized for Myocardial Infarction in 2016–2021

The influence of clinical and medical history factors and anti-thrombotic therapy on the prognosis in patients with atrial fibrillation and myocardial infarction

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