Quality of Vitamin K Antagonist Anticoagulation in Spain: Prevalence of Poor Control and Associated Factors

Sánchez, Manuel Anguita; Martínez, Vicente Bertoméu; Fillat, Ángel Cequier

doi:10.1016/j.rec.2014.11.019

Cited by 20 publications

(27 citation statements)

References 33 publications

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“…Our study suggests that satisfaction with oral anticoagulation may be high in AF patients who attended internal medicine departments daily. Since the majority of the studies that have analyzed patients with AF have focused on patients visiting cardiologists or general practitioners, 21 , 22 the information provided in this study is of great interest, considering the high number of AF patients who are currently attending internal medicine departments.…”

Section: Discussionmentioning

confidence: 99%

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Satisfaction with oral anticoagulants in patients with atrial fibrillation

Fernández¹,

Castilla-Guerra²,

Hinojosa³

et al. 2018

PPA

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BackgroundAlthough, by itself, atrial fibrillation is associated with an impairment of quality of life antithrombotic therapy may play a role.ObjectiveTo evaluate the satisfaction with anticoagulant treatment in patients with nonvalvular atrial fibrillation who attended internal medicine departments in Spain.MethodsPatients from two different cross-sectional studies were combined. To measure the satisfaction with anticoagulant treatment, the Anti-Clot-Treatment Scale (ACTS) questionnaire was completed by every patient. A multivariate analysis was performed to determine the variables associated with satisfaction of patients receiving oral anticoagulants.ResultsA total of 1,309 patients (mean age 78.5±8.4 years; 49.3% men; CHA2DS2VASC 4.9±1.5; HAS-BLED 2.0±0.9) were included in the study, of whom 902 (68.9%) were taking vitamin K antagonists (VKA) and 407 (31.1%) direct oral anticoagulants (DOACs). Overall, satisfaction with oral anticoagulation was high (ACTS Burdens scale 49.69±9.45; ACTS Benefits scale 11.35±2.61). The perceived burdens with anticoagulant treatment were lower in men, as well as in patients with no dependency, normal renal function, who were not polymedicated, or who had moderate bleeding risk. Among patients taking VKA, those subjects with a lower number of International Normalized Ratio (INR) determinations in the last 6 months or with an optimal time in the therapeutic range exhibited a lower perceived burden. Patients taking DOACs (vs VKA) showed a lower perceived burden with anticoagulation. Benefits with anti-coagulation were higher in men, younger patients, those with no dependency, or low bleeding risk. Perceived benefits were higher in patients taking DOACs (vs VKA).ConclusionSatisfaction with oral anticoagulation was high in patients with nonvalvular atrial fibrillation, who were attending internal medicine departments daily in Spain. Among patients taking VKA, those subjects with a lower number of INR determinations in the last 6 months or with an optimal time in the therapeutic range exhibited a lower perceived burden with anticoagulant therapy. Patients taking DOACs (vs VKA) showed lower perceived burdens and higher perceived benefits with anticoagulation.

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Section: Discussionmentioning

confidence: 99%

“… 26 Unfortunately, poor INR control is very common in clinical practice, since up to 40%–50% of patients taking VKA do not achieve an adequate time in the therapeutic range. 21 , 22 …”

Section: Discussionmentioning

confidence: 99%

Satisfaction with oral anticoagulants in patients with atrial fibrillation

Fernández¹,

Castilla-Guerra²,

Hinojosa³

et al. 2018

PPA

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“…Some recently published studies in Spain stress on the high percentage of patients who are not well controlled with VKAs. These values range from 41.5% to 43.7%, according to the results of the CALIFA study,42 and the ANFAGAL study43 the prevalence of poorly controlled VKA anticoagulation in Spain in patients with non-valvular AF.…”

Section: Discussionmentioning

confidence: 99%

Adverse drug reactions to anticoagulants in Spain: analysis of the Spanish National Hospital Discharge Data (2010–2013)

et al. 2017

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ObjectiveTo describe and analyse hospitalisations for adverse drug reactions (ADRs) involving anticoagulants. We also analysed the progress of the reactions over time, the factors related with ADRs.DesignA retrospective, descriptive, epidemiological study.SettingThis study used the Spanish National Hospital Discharge Database (Conjunto Mínimo Básico de Datos, CMBD), over a 4-year period.ParticipantsWe selected CMBD data corresponding to hospital discharges with a diagnosis of ADRs to anticoagulants (International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM) code E934.2) in any diagnostic field during the study period.Main outcome measuresWe calculated the annual incidence of ADRs to anticoagulants according to sex and age groups. The median lengths of hospital stay and in-hospital mortality (IHM) were also estimated for each year studied. Bivariate analyses of the changes in variables according to year were based on Poisson regression. IHM was analysed using logistic regression models. The estimates were expressed as ORs and their 95% CI.ResultsDuring the study period, 50 042 patients were hospitalised because of ADRs to anticoagulants (6.38% of all ADR-related admissions). The number of cases increased from 10 415 in 2010 to 13 891 in 2013. Cumulative incidence of ADRs to anticoagulants was significantly higher for men than women and in all age groups. An adjusted multivariate analysis revealed that IHM did not change significantly over time. We observed a statistically significant association between IHM and age, with the highest risk for the ≥85 age group (OR 2.67; 95% CI 2.44 to 2.93).ConclusionsThe incidence of ADRs to anticoagulants in Spain increased from 2010 to 2013, and was significantly higher for men than women and in all age groups. Older patients were particularly susceptible to being hospitalised with an adverse reaction to an anticoagulant.

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“…VKAs have important limitations that make their use problematic, such as slow onset of action, a narrow therapeutic window making it difficult to maintain an optimal range, high potential for food and drug interactions, and unpredictable anticoagulant effect [ 3 ]. However, no robust data regarding the use of NOACs as a thrombolytic agent in patients with an intra-atrial thrombus exist to date.…”

Section: Discussionmentioning

confidence: 99%

“…Oral anticoagulation (OAC) is considered mandatory before ambulatory electrical cardioversion (ECV) of the AF in order to reduce the risk of thromboembolic complications related to the procedure and derived from intra-atrial thrombus formation, mainly located in the left atrial appendage (LAA) [ 1 , 2 ]. Vitamin K antagonists (VKAs) have been the classic OAC therapy, but one of the main problems of VKAs is the difficulty in maintaining an adequate time-in-therapeutic range (TTR) of the optimal international normalized ratio (INR) in daily clinical practice [ 3 ]. In this context, novel oral anticoagulants (NOACs) were developed.…”

Section: Introductionmentioning

confidence: 99%

Thrombolytic Action of Apixaban on Intra-Atrial Thrombus Developed after Previous Treatment with Warfarin: A Case Report

Valero

Santas²,

Núñez³

2016

Med Princ Pract

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Objective: To highlight the usefulness of apixaban on intra-atrial thrombus that develops after previous treatment with warfarin. Clinical Presentation and Intervention: A 69-year-old woman with a history of atrial fibrillation treated with warfarin presented with acute decompensated heart failure due to an episode of atrial fibrillation. Transesophageal echocardiogram revealed the presence of an intra-atrial thrombus. She was treated with apixaban, and transesophageal echocardiogram showed complete resolution of the thrombus after 3 weeks of treatment. Conclusion: This case highlights the usefulness of apixaban in the management of atrial fibrillation and proven intra-atrial thrombus.

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Quality of Vitamin K Antagonist Anticoagulation in Spain: Prevalence of Poor Control and Associated Factors

Cited by 20 publications

References 33 publications

Satisfaction with oral anticoagulants in patients with atrial fibrillation

Satisfaction with oral anticoagulants in patients with atrial fibrillation

Adverse drug reactions to anticoagulants in Spain: analysis of the Spanish National Hospital Discharge Data (2010–2013)

Thrombolytic Action of Apixaban on Intra-Atrial Thrombus Developed after Previous Treatment with Warfarin: A Case Report

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