Prevalence of oral anticoagulation in atrial fibrillation

Bartholomay, Eduardo; Polli, Ismael; Borges, Anibal Pires; Kalil, Carlos; Arroque, André; Köhler, Ilmar; Danzmann, Luiz Cláudio

doi:10.6061/clinics/2014(09)07

Cited by 14 publications

(12 citation statements)

References 30 publications

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“…The role of oral anticoagulation therapy (OAT) in reducing the prospects of developing thromboembolisms has been discussed in literature. For example, the use of VKAs decreases the possibility of developing a CVA by almost 30% in the patients at risk for thromboembolic events [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

The prevalence of long-term oral anticoagulation therapy in a cardiology center in Bucharest, Romania

Sorescu

Enache

Guberna

2018

Medicine and Pharmacy Reports

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Background and aimsFew studies discuss the prevalence of oral anticoagulation therapy (OAT) in clinical practice, despite their increasing use worldwide. In America, studies established that 20% to 80% of the patients with indication benefit from OAT. In Romania, there is no data regarding the utilization of oral anticoagulants. Thus, this study aims to determine the trends of OAT.MethodsWe designed a cross-sectional study of the patients admitted to the Cardiology Department of the “Bagdasar-Arseni” Clinical Emergency Hospital, Bucharest, from the 1st of November 2016 until the 31st of January 2017. We considered OAT indications to be: atrial fibrillation/flutter (AF), pulmonary embolisms (PE), deep vein thrombosis (DVT), intramural or intracavitary thrombi and left ventricle aneurysms. Statistical analysis was performed with EpiInfo.ResultsThere were 783 patients admitted, 253 of these having an OAT indication (mean age 73.25 years, 53.75% female). Only 162 patients (64.03%) received it, either Vitamin K Antagonists (VKA) (78 patients, 48.14%), or Novel Oral Anticoagulants (NOAC) (84 patients, 51.85%). Reasons for not indicating such therapy included the hemorrhage risk (43.27%), the lack of adherence to the treatment (18.56%), the impossibility of INR monitoring (21.84%), the economic status (10.21%) and others (6.12%). 221 patients had AF (87.35%), 141 (63.8%) receiving OAT, VKA (67 patients, 47.51%), or NOAC (74 patients, 52.48%). 17 patients (6.71%) had a PE and/or DVT. 15 (88.23%) received OAT, AVK (11 patients, 73.33%), or NOAC (4 patients, 26.67%). 15 patients (5.92%) had other OAT indications (excepting AF or PE/DVT), 11 receiving OAT (73.33%), AVK (8 patients, 72.72%), or NOAC (3 patients, 27.27%).ConclusionsOur study determined that 64.03% of those with indication received OAT. Similar data is reported in the USA, suggesting an underuse of anticoagulants. The risk of hemorrhage, lack of adherence, the impossibility of INR monitoring or the economic status were some of the reasons for not recommending OAT.

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Section: Discussionmentioning

confidence: 99%

The prevalence of long-term oral anticoagulation therapy in a cardiology center in Bucharest, Romania

Sorescu

Enache

Guberna

2018

Medicine and Pharmacy Reports

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“…It has been shown that patients who have attended tertiary centers and have access to cardiologists are more likely to be prescribed appropriate anticoagulation compared to physicians of other specialties. 97 This may be due to the difficulty of returning to the same treatment center for monitoring and treatment. 97 However, educating non-specialist physicians regarding the benefits of anticoagulation may be another factor that could improve the use of anticoagulation.…”

Section: Methodsmentioning

confidence: 99%

“…97 This may be due to the difficulty of returning to the same treatment center for monitoring and treatment. 97 However, educating non-specialist physicians regarding the benefits of anticoagulation may be another factor that could improve the use of anticoagulation.…”

Section: Methodsmentioning

confidence: 99%

“…However, the lack of these drugs within the public health system of many nations is a significant obstacle to their widespread use. 97 There has been a study showing the potential benefits of apixaban in Latin America, suggesting the use of NOACs in this region may be favorable due to perceived benefits in practice compared to VKA therapy. 98 The more urgent issue that needs to be addressed in the region is the recognition of the value of anticoagulation with VKAs or NOACs in the prevention of stroke, as many physicians do not prescribe these agents appropriately.…”

Section: Methodsmentioning

confidence: 99%

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Stroke Prevention in Atrial Fibrillation: Focus on Latin America

Massaro¹,

Lip²

2016

Arquivos Brasileiros De Cardiologia

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with an estimated prevalence of 1-2% in North America and Europe. The increased prevalence of AF in Latin America is associated with an ageing general population, along with poor control of key risk factors, including hypertension. As a result, stroke prevalence and associated mortality have increased dramatically in the region. Therefore, the need for effective anticoagulation strategies in Latin America is clear. The aim of this review is to provide a contemporary overview of anticoagulants for stroke prevention.The use of vitamin K antagonists (VKAs, eg, warfarin) and aspirin in the prevention of stroke in patients with AF in Latin America remains common, although around one fifth of all AF patients receive no anticoagulation. Warfarin use is complicated by a lack of access to effective monitoring services coupled with an unpredictable pharmacokinetic profile. The overuse of aspirin is associated with significant bleeding risks and reduced efficacy for stroke prevention in this patient group. The non-VKA oral anticoagulants (NOACbs) represent a potential means of overcoming many limitations associated with VKA and aspirin use, including a reduction in the need for monitoring and a reduced risk of hemorrhagic events.The ultimate decision of which anticoagulant drug to utilize in AF patients depends on a multitude of factors. More research is needed to appreciate the impact of these factors in the Latin American population and thereby reduce the burden of AF-associated stroke in this region.

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“…A retrospective study in Ontario of hospitalizations for ischemic stroke between 2003 and 2007 showed that among a very high-risk group of patients with AF, a previous ischemic stroke or transient ischemic attack (TIA), and no known contraindications to anticoagulants, only 18% were receiving warfarin and in the desirable INR range on pre-admission [3]. Despite recent studies showing increase in use of oral anticoagulants (OAC) [16–18], anticoagulation therapy still remains suboptimal among patients with AF [19–22]. …”

Section: Introductionmentioning

confidence: 99%

Improving stroke prevention therapy for patients with atrial fibrillation in primary care: protocol for a pragmatic, cluster-randomized trial

et al. 2016

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BackgroundThe prevalence of atrial fibrillation (AF) is growing as the population ages, and at least 15% of ischemic strokes are attributed to AF. However, many high-risk AF patients are not offered guideline-recommended stroke prevention therapy due to a variety of system, provider, and patient-level barriers.MethodsWe will conduct a pragmatic, cluster-randomized controlled trial randomizing primary care clinics to test a “toolkit” of quality improvement interventions in primary care. In keeping with the recommendations of the chronic care model to simultaneously activate patients and facilitate proactive care by providers, the toolkit includes provider-focused strategies (education, audit and feedback, electronic decision support, and reminders) plus patient-directed strategies (educational letters and reminders). The trial will include two feedback cycles at baseline and approximately 6 months and a final data collection at approximately 12 months. The study will be powered to show a difference of 10% in the primary outcome of proportion of patients receiving guideline-recommended stroke prevention therapy. Analysis will follow the intention-to-treat principle and will be blind to treatment allocation. Unit of analysis will be the patient; models will use generalized estimating equations to account for clustering at the clinical level.DiscussionStroke prevention therapy using anticoagulation in patients with AF is known to reduce strokes by two thirds or more in clinical trials, but most studies indicate under-use of this treatment in real-world practice. If the toolkit successfully improves care for patients with AF, stakeholders will be engaged to facilitate broader application to maximize the potential to improve patient outcomes. The intervention toolkit tested in this project could also provide a model to improve quality of care for other chronic cardiovascular conditions managed in primary care.Trial registrationClinicalTrials.gov (NCT01927445). Registered August 14, 2014 at https://clinicaltrials.gov/.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0523-2) contains supplementary material, which is available to authorized users.

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Prevalence of oral anticoagulation in atrial fibrillation

Cited by 14 publications

References 30 publications

The prevalence of long-term oral anticoagulation therapy in a cardiology center in Bucharest, Romania

The prevalence of long-term oral anticoagulation therapy in a cardiology center in Bucharest, Romania

Stroke Prevention in Atrial Fibrillation: Focus on Latin America

Improving stroke prevention therapy for patients with atrial fibrillation in primary care: protocol for a pragmatic, cluster-randomized trial

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