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Vol. 30. Issue 2.
Pages 56-63 (March - April 2018)
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Vol. 30. Issue 2.
Pages 56-63 (March - April 2018)
Original article
DOI: 10.1016/j.artere.2018.03.002
Assessment of anticoagulation treatments in non-valvular atrial fibrillation patients diagnosed in a basic health area
Valoración del tratamiento anticoagulante en pacientes diagnosticados de fibrilación auricular no valvular en una zona básica de salud
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Beatriz M. Aguilera Alcaraza,
Corresponding author
bea.aguilera.alcaraz@gmail.com

Corresponding author.
, José Abellán Huertaa, Julio Antonio Carbayo Herenciaa, Consuelo Ariza Copadob, Fernando Hernández Menárgueza, José Abellán Alemána
a Cátedra de Riesgo Cardiovascular, Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain
b Centro de Salud Isaac Peral, Área 2 de Atención Primaria, Cartagena, Spain
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Tables (4)
Table 1. Epidemiological and clinical characteristics of the study sample.
Table 2. Association between thromboembolic risk and anticoagulation.
Table 3. Treatment prescribed according to permanent/persistent or paroxysmal atrial fibrillation.
Table 4. Crude odds ratio and odds ratio adjusted for different variables in those patients at high thromboembolic risk, according to the CHA2DS2-VASC scoring system, whose INR is not in therapeutic range.
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Abstract
Introduction

Atrial fibrillation (AF) is the most common cardiac arrhythmia. To assess the need for anticoagulation is essential for its management. Our objective was to investigate whether the indication of anticoagulation was adequate in patients diagnosed with non-valvular AF, given the CHA2-DS2-VASc scale, measuring the International Normalized Ratio range (INR) in patients treated with anti-vitamin K drugs.

Methods

This is an observational and cross sectional study. 232 patients with atrial fibrillation were included. We analysed demographic, the CHA2-DS2-VASc and HAS-BLED variables, the treatment and INR values for 6 consecutive months. The confrontation of variables was performed using chi-square and Mantel-Haenzel test.

Results

The prevalence of AF was 1.05%. The 88.4% had CHA2-DS2-VASc ≥2. The 71.1% were taking anticoagulants, of which 58.2% were under antivitamin K. The 46.7% of patients taking antivitamin K, presented inadequate range of INR. There was a greater prescription of antivitamin K in patients with persistent or permanent AF compared to the paroxysmal form (62.8 vs. 37.2% p<0.001). The use of drugs that increase bleeding was associated with a worse control of INR after adjustment for the main variables of clinical relevance (odds ratio 2.17 [1.02–4.59], p=0.043).

Conclusions

The level of anticoagulation with antivitamin K was inadequate in our sample, despite a proper follow up and adherence to treatment. Patients with paroxysmal AF received less antivitamin K than those with persistent/permanent AF.

Keywords:
Atrial fibrillation
Anticoagulants agents
Thrombosis
Haemorrhage
Resumen
Introducción

La fibrilación auricular (FA) es la arritmia cardiaca más frecuente. En su manejo, es clave valorar la necesidad de anticoagulación. Nuestro objetivo fue valorar en pacientes diagnosticados de FA no valvular si la indicación de anticoagulación es adecuada en función de la escala CHA2DS2-VASc y la adecuación del rango del International Normalizad Ratio (INR) en los pacientes en tratamiento con antivitamina K.

Métodos

Estudio observacional, analítico transversal. Se seleccionaron 232 pacientes con diagnóstico de FA no valvular. Se han analizado variables demográficas, variables de la escala CHA2DS2-VASc, tratamiento prescrito y valores de INR durante 6 meses consecutivos. La comparación de variables se realizó con ji cuadrado y la tendencia lineal entre grupos por Mantel Haenzel, siendo calculadas las odds ratios.

Resultados

La prevalencia total de FA no valvular en el área fue 1,05%. El 88,4% presentó un CHA2DS2-VASc ≥ 2. Un 71,1% de pacientes con fibrilación auricular estaban anticoagulados, de los que el 58,2% tomaban fármacos antivitamina K. El 46,7% de los pacientes en tratamiento con acenocumarol presentó un INR con un tiempo en rango terapéutico directo insuficiente. La prescripción de antivitamina K en los pacientes con FA permanente fue superior que en pacientes con FA paroxística (62,8 vs. 37,2%, p<0,001). El consumo de fármacos que aumentan el sangrado se asoció a un peor control de INR (tras ajuste por las principales variables de relevancia clínica (odds ratio 2,17 [1,02-4,59], p=0,043).

Conclusiones

El control de la anticoagulación oral con antivitamina K fue subóptimo pese a la adecuada adherencia de los pacientes. Los pacientes con FA paroxística recibieron menos antivitamina-K que los de FA persistente/permanente.

Palabras clave:
Fibrilación auricular
Anticoagulantes
Trombosis
Hemorragia

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