Use of Antithrombotic Therapy According to CHA2DS2-VASc Score in Patients With Atrial Fibrillation in Primary Care

Barrios, Vivencio; Escobar, Carlos; Calderón, Alberto; Roca, G.C. Rodríguez; Llisterri, J.L.; García, J. Polo

doi:10.1016/j.rec.2013.07.009

Cited by 12 publications

(13 citation statements)

References 6 publications

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“…The great majority of patients with AF should be anticoagulated for the prevention of stroke. 4 Although AF is associated with an impairment of quality of life by itself, antithrombotic therapy may play a role in this context. 5 …”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

Satisfaction with oral anticoagulants in patients with atrial fibrillation

Fernández¹,

Castilla-Guerra²,

Hinojosa³

et al. 2018

PPA

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“…3,4 Although vitamin K antagonists, such as warfarin, have proven effective for stroke prevention, 5 their shortcomings (eg, marked inter and intraindividual variations in medication dosage, narrow therapeutic window, frequent monitoring of anticoagulant activity, and interactions with other drugs) would limit their use in clinical practice. 6,7 More recently, 4 phase III randomized clinical trials (RCTs) have demonstrated that non–vitamin K antagonist oral anticoagulants (NOACs) are at least as effective as vitamin K antagonists and even have a better safety profile in the worldwide AF patients. 8–11…”

mentioning

confidence: 99%

Non–Vitamin K Antagonist Oral Anticoagulants Versus Warfarin in Asians With Atrial Fibrillation

Xue

Zhang

2019

Stroke

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Background and Purpose— Several randomized trials and real-world studies have reported the efficacy and safety of non–vitamin K antagonist oral anticoagulants (NOACs) in Asian patients with atrial fibrillation; and therefore, this meta-analysis was aimed to compare the effects of NOACs with warfarin for atrial fibrillation stroke prevention in Asians. Methods— The PubMed and Embase databases were searched from January 2009 to February 2019 for studies on comparisons of NOACs versus warfarin in Asians. Risk ratios (RRs) with 95% CIs were pooled using a random-effects model. Results— Five NOAC trials and 21 observational cohorts were included. For the NOAC trials, compared with warfarin, NOACs was associated with reduced risks of stroke or systemic embolism (RR, 0.73; 95% CI, 0.59–0.90), all-cause death (RR, 0.83; 95% CI, 0.73–0.95), major bleeding (RR, 0.59; 95% CI, 0.48–0.72), and intracranial bleeding (RR, 0.36; 95% CI, 0.26–0.49). For the real-world data, compared with warfarin, NOACs was associated with decreased rates of stroke or systemic embolism (RR, 0.75; 95% CI, 0.68–0.82), ischemic stroke (RR, 0.70; 95% CI, 0.59–0.83), myocardial infarction (RR, 0.74; 95% CI, 0.58–0.93), all-cause death (RR, 0.67; 95% CI, 0.59–0.77), major bleeding (RR, 0.63; 95% CI, 0.55–0.73), intracranial bleeding (RR, 0.50; 95% CI, 0.43–0.59), and gastrointestinal bleeding (RR, 0.65; 95% CI, 0.51–0.84). The results did not change in the subgroup analyses based on the type and dose of NOACs. Conclusions— Based on published NOAC trials and real-world studies, the use of NOACs is noninferior to warfarin in Asians with atrial fibrillation irrespective of the NOAC type and dose.

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“…En las guías europeas 3 recientemente publicadas la indicación de ACO es opcional en CHA 2 DS 2 -VASc = 1, a diferencia de la firme recomendación vigente previamente de ACO en este subgrupo. Un nexo común de nuestros datos con otras series17, 23, 24 es que los pacientes con FA persistente-permanente están anticoagulados en mayor medida frente a los sujetos con FA paroxística, cuando es conocido que la indicación de ACO es independiente del tipo de FA 3 .…”

Section: Discussionunclassified

“…Entre los pacientes sin ACO de nuestro estudio, el tratamiento antiagregante aislado (fundamentalmente ácido acetilsalicílico) alcanzó el 15%. La prescripción de antiagregantes aislados para el tratamiento de la FA muestra una amplia variabilidad entre las series, desde el 11,2 hasta el 36,5%18, 19, 20, 21, 22, 23, 24. En el reciente registro GLORIA-AF 17 los antiagregantes aún se prescribieron en el 11,5% de pacientes, aunque con importantes diferencias regionales.…”

Section: Discussionunclassified

“…En el reciente registro GLORIA-AF 17 los antiagregantes aún se prescribieron en el 11,5% de pacientes, aunque con importantes diferencias regionales. Los pacientes sin tratamiento antitrombótico representaron el 10% de nuestro registro, y al igual que ocurre con el tratamiento antiagregante aislado, la variabilidad es muy amplia entre los estudios18, 19, 20, 21, 22, 23, 24. Inversamente, el 37% de los pacientes con bajo riesgo por CHA 2 DS 2 -VASc = 0 recibían ACO, similar a las cifras registradas en el estudio GARFIELD 22 , pero inferior al 45,9% del Val-FAAP 24 o al 62,5% del PREFER 19 , aunque en este último se incluyeron los que estaban pendientes de cardioversión.…”

Section: Discussionunclassified

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