Tactics of Selection of Anticoagulant Therapy in Patients With Atrial Fibrillation and Ischemic Heart Disease

Belenkov, Yu. N.; Shakaryants, G. A.; Khabarova, N V

doi:10.18087/cardio.2018.3.10098

Cited by 4 publications

(3 citation statements)

References 27 publications

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“…При наличии высокого риска тромбоэмболических ослож нений АКТ показана во всех случаях ФП не зависимо от выбранной стратегии ведения пациента (контроль ритма или частоты сердечных сокращений) [16]. Несмотря на убедительные доказательства преимущества НОАК в профилактике кардиоэмболических осложнений в сравнении с варфарином [16], до сих пор распространены си-туации неадекватного дозирования, досрочного прекращения терапии или отказа от ее назначения. Основными причинами этого являются геморрагические осложнения, предполагаемый высокий риск кровотечений и неудобство мониторинга показателей коагулограммы [13].…”

Section: Discussionunclassified

Efficacy and safety of anticoagulant treatment for non-valvular atrial fibrillation in multimorbid patients

2020

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Objective. Assessment of the safety and efficacy of anticoagulant treatment in patients with nonvalvular atrial fibrillation (AF) in a multimorbidity setting.Materials and Methods. The cross-sectional study included 104 patients diagnosed with nonvalvular AF and followed in the medical facilities of Yekaterinburg. The subjects were interviewed, anthropometric measurements were made, and the risk of thromboembolic complications was evaluated using the CHA2DS2-VASc score. The Charlson multimorbidity index was calculated, and patients were divided into two groups: Group 1 with a low level of multimorbidity (not more than 5 points) and Group 2 with a high level of multimorbidity (6 points or more). The data are presented as a median and interquartile range (25%; 75%).Results.The study population included 40 males and 64 females. The median age was 71 (62.5; 80) years. The level of multimorbidity was estimated as 5 (3; 6) points. Group 1 included 64 patients, and Group 2 included 40 patients. Thirty-nine percent of the sample patients had a paroxysmal form of AF, 10% had a persistent form, and 51% had permanent AF. The group of patients with a high level of multimorbidity included more patients with permanent AF and fewer patients with paroxysmal AF as compared with a moderate level of multimorbidity (p<0.01). Anticoagulant treatment was indicated for 92 (88.5%) patients. It was administered to 70.7% of patients; 29.3% did not receive it. Among patients receiving anticoagulants, warfarin was administered to 18.5%, and new oral anticoagulants (NOACs) were administered to 81.5%. Complications were reported in 15.2% of anticoagulant treatment cases. Bleeding was reported in 21.7% of cases of warfarin administration and 12.5% of cases of NOAC treatment (p=0.32). The median number of risk factors for bleeding per patient was 5 (4; 5.5). The Charlson index and the total number of risk factors are significantly correlated (R=0.37, p<0.05).Conclusion. In real-world clinical practice in Ekaterinburg, Russia, 7 of 10 patients with AF for whom anticoagulant treatment was indicated actually received it; NOACs are prescribed four times more often than warfarin. With a higher level of multimorbidity, the risk of bleeding under the pressure of anticoagulant treatment increases; thus, NOACs should be preferred over warfarin for treatment of multimorbid patients.

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Section: Discussionunclassified

Efficacy and safety of anticoagulant treatment for non-valvular atrial fibrillation in multimorbid patients

2020

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“…Существует большая доказательная база эффективности применения антикоагулянтов (АК) -как варфарина, так и новых пероральных АК (ПОАК), для снижения риска развития не только инсульта, но и ИМ [5,34,35]. Причем, по результатам крупных мета-анализов K.-H. Mak (2012) и A. Tornyos и соавт.…”

Section: особенности антитромботической терапии у больных им и фпunclassified

“…Данные работы показали, что по сравнению с трехкомпонентной АТТ, включающей варфарин, ПОАК ривароксабан (в дозах 15 мг или 10 мг при клиренсе креатинина 30-50 мл / мин в сочетании с клопидогрелом либо 2,5 мг в сочетании с двухкомпонентной антиагрегантной терапией), дабигатран (в дозах 110 мг или 150 мг 2 раза в сутки в сочетании с клопидогрелом) и апиксабан (в дозах 5 мг 2 раза в сутки или 2,5 мг 2 раза в сутки при наличии 2 из следующих критериев и более: возраст 80 лет и старше, масса тела ≤60 кг, уровень креатинина ≥133 мкмоль / л в сочетании с двухкомпонентной антиагрегантной терапией или только с клопидогрелом), были более безопасны [35,[45][46][47]. При этом эффективность терапии ПОАК в отношении профилактики системных эмболий в этих исследованиях не уступала варфарину, однако, не являлась первичной точкой исследований.…”

Section: особенности антитромботической терапии у больных им и фпunclassified

Myocardial Infarction in the Group of Patients With Atrial Fibrillation

et al. 2020

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Prevalence of patients with myocardial infarction (MI) and atrial fibrillation (AF) has been growing every year. These patients represent a highest risk group and, thus, require special attention of clinicians. The article foсused on mechanisms of the AF and MI interaction, special aspects of prediction depending on the type of AF and MI, and the issue of antithrombotic therapy in this patient category. A group of AF-associated, embologenic MIs was isolated, and diagnostic criteria and therapeutic regimens were provided.

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Antithrombotic therapy and its impact on prognosis in patients with atrial fibrillation and myocardial infarction. Long-term observation results

Соловьева

Болдуева

2021

CardioSomatics

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Aim. To study antithrombotic therapy (ATT) in patients with myocardial infarction (MI) type 1 and preexisting atrial fibrillation (AF), effect of ATT on prognosis. Material and methods. 100 patients with type 1 MI and preexisting AF were selected. The exclusion criterion was severe concomitant pathology. Results. Only 13.0% of AF patients took anticoagulants (AC) adequately before hospitalization. 94.0% of patients in hospital and 80.5% at discharge were prescribed triple ATT at least for 1 month with transition to dual ATT (AC + disaggregant) for 12 months. ACs were prescribed in hospital in 100.0% of cases, at discharge in 93.1%. After 1 year 8.4% of patients stopped taking ACs, after 2.31.9 years 15.7%. The incidence of ischemic and hemorrhagic events didnt differ in patients with different regimens of ATT (double/triple) and types of AСs (vitamin K antagonists/non-vitamin K antagonist ACs). In the long-term period patients, who took ACs incorrectly or stopped taking ACs, had increased risks of stroke (OR 9.580; 95% CI 1.15379.599, p=0.0365); combined endpoint: recurrent MI + stroke + cardiovascular mortality (OR 2.556; 95% CI 1.1045.918, p=0.0284). Сonclusion. Patients with preexisting AF had a low adherence to ACs prior to MI. It increased after hospitalization and decreased during follow-up. In the long-term period patients, who took ACs incorrectly or stopped taking ACs, had significantly increased risks of stroke, combined endpoint. There were no differences in the prognosis depending on the type of ACs, the regimens of ATT administered in accordance with ischemic and hemorrhagic risks.

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Tactics of Selection of Anticoagulant Therapy in Patients With Atrial Fibrillation and Ischemic Heart Disease

Cited by 4 publications

References 27 publications

Efficacy and safety of anticoagulant treatment for non-valvular atrial fibrillation in multimorbid patients

Efficacy and safety of anticoagulant treatment for non-valvular atrial fibrillation in multimorbid patients

Myocardial Infarction in the Group of Patients With Atrial Fibrillation

Antithrombotic therapy and its impact on prognosis in patients with atrial fibrillation and myocardial infarction. Long-term observation results

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