Misuse of antithrombotic therapy in atrial fibrillation patients: frequent, pervasive and persistent

Fornari, Lucimara Fabiana; Calderaro, Daniela; Nassar, Ivana B.; Lauretti, Cristiane Nogueira; Nakamura, Lidia; Bagnatori, Renato Scotti; Ageno, Walter; Caramelli, Bruno

doi:10.1007/s11239-006-9012-9

Cited by 34 publications

(24 citation statements)

References 50 publications

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“…12 Further publications revealed that this index is increasing, but it is still very far from what is desired. [9][10][11]13 OAC use frequency in the sample presented here (55%) is similar to the one reported in the studies with the best results. [9][10][11] In a recent analysis of the UK data bank, that comprises 12,267 AF patients, 53% of the men and 40% of the women were using OAC, and only 56.5% of those who had high embolic risk received anticoagulant.…”

Section: Discussionsupporting

confidence: 84%

“…[9][10][11]13 OAC use frequency in the sample presented here (55%) is similar to the one reported in the studies with the best results. [9][10][11] In a recent analysis of the UK data bank, that comprises 12,267 AF patients, 53% of the men and 40% of the women were using OAC, and only 56.5% of those who had high embolic risk received anticoagulant. 9 A group in the Heart Institute at the Universidade de São Paulo reported that, after a year of follow up in the division, 57.8% of the AF patients and only 60.4% of the patients with previous ischemic stroke were receiving OAC.…”

Section: Discussionsupporting

confidence: 83%

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

Macedo¹,

Neto

Silva³

et al. 2010

Rev. Assoc. Med. Bras.

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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.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 83%

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

Macedo¹,

Neto

Silva³

et al. 2010

Rev. Assoc. Med. Bras.

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“…103 In a Brazilian study, the proportion of patients with AF receiving warfarin in whom a random sample demonstrated an INR within the therapeutic range was only 16-26%. 104,105 Physicians in developing countries therefore have legitimate concerns around bleeding, access to monitoring and patient education to permit safe use of warfarin.…”

Section: Patient-level Interventions To Decrease Stroke Risk In Metabmentioning

confidence: 99%

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

2015

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“…Probably because of that, patients with AF using warfarin are undertreated or stay for a long time outside the therapeutic index. [5][6][7] Nevertheless, warfarin has proven to be effective and safe for the prevention of neurovascular events in different subgroups of patients in the last 60 years. Recently, new anticoagulant drugs were developed and revealed to be non-inferior to warfarin for the prevention of stroke.…”

Section: Introductionmentioning

confidence: 99%

Design and protocols of the GIRAF prevention trial: A randomized, prospective, parallel, two-center study to compare cognitive outcomes in subjects with atrial fibrillation using warfarin or dabigatran

Toledo

Guallandro

et al. 2015

Int J Clin Trials

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Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with cognitive impairment and dementia. Cognitive and functional impairments have been neglected in clinical trials with patients affected by AF. Dabigatran is a new drug, which can offer a more stable long-term anticoagulant therapy compared to warfarin. This advantage could be associated with a minor incidence of cognitive and functional decline. The objective of the study is to evaluate the effects of dabigatran compared with warfarin on cognitive and functional impairments, thrombin production, bleeding occurrence and cerebrovascular complications in elderly patients with AF.Methods: A randomized, prospective parallel, two-center, active-controlled trial will be performed in a sample of 200 patients with AF randomly designated to take dabigatran (150 mg twice daily) or warfarin (once daily, dose controlled by INR between 2 and 3). After one and two years, subjects will be assessed considering cognitive outcomes. Additionally, patients will be submitted to brain magnetic resonance imaging (MRI) at the beginning and ending of study to identify possible cerebrovascular events, as well as carotid ultrasonography to search for atherosclerotic disease.Conclusions: The GIRAF study expects to provide data about prevention of cognitive and functional impairments among patients on anticoagulant therapy for AF, and to explore new concepts on potential prevention of cognitive decline and benefits for AF patients and their relatives.

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Misuse of antithrombotic therapy in atrial fibrillation patients: frequent, pervasive and persistent

Abstract: Anticoagulation is underused in AF patients and neither the fact of being treated by cardiologists in a University Hospital, nor the learning time-window of 1 year seemed to improve the antithrombotic care significantly.

Cited by 34 publications

References 50 publications

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

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

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

Design and protocols of the GIRAF prevention trial: A randomized, prospective, parallel, two-center study to compare cognitive outcomes in subjects with atrial fibrillation using warfarin or dabigatran

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