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Inicio Medicina Clínica (English Edition) Adherence to recommendations of the Therapeutic Positioning Report about treatme...
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Vol. 151. Issue 1.
Pages 8-15 (July 2018)
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Vol. 151. Issue 1.
Pages 8-15 (July 2018)
Original article
DOI: 10.1016/j.medcle.2018.05.002
Adherence to recommendations of the Therapeutic Positioning Report about treatment with oral anticoagulants in elderly patients with atrial fibrillation. The ESPARTA study
Seguimiento de las recomendaciones del Informe de Posicionamiento Terapéutico sobre el tratamiento con anticoagulantes orales en pacientes ancianos con fibrilación auricular. Estudio ESPARTA
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Carmen Suárez Fernándeza,
Corresponding author
csuarezf@salud.madrid.org

Corresponding author.
, Jose María Mostazab, Luis Castilla Guerrac, Jesus Cantero Hinojosad, Josep Maria Suriñache, Fernando Acosta de Bilbaof, Juan José Tamaritg, José Luis Diaz Diazh, Jose Luis Hernandezi, Daniel Cazorlaj, Carles Ràfolsj, on behalf of the Researchers of the Estudio ESPARTA
a Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, Spain
b Servicio de Medicina Interna, Hospital Carlos III, Madrid, Spain
c Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
d Servicio de Medicina Interna, Hospital San Cecilio, Granada, Spain
e Servicio de Medicina Interna, Hospital Vall d’Hebron, Barcelona, Spain
f Servicio de Medicina Interna, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Las Palmas, Spain
g Servicio de Medicina Interna, Hospital General de Valencia, Valencia, Spain
h Servicio de Medicina Interna, Complejo Universitario Hospitalario de A Coruña, La Coruña, Spain
i Servicio de Medicina Interna, Hospital Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain
j Departamento Médico, Bayer Hispania S. L., Barcelona, Spain
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Tables (7)
Table 1. Patient distribution (No.=837) and compliance with the Therapeutic Positioning Report by autonomous regions.
Table 2. Characteristics of the sample (No.=837).
Table 3. Regimen of patients on treatment with direct oral anticoagulants.
Table 4. Reasons for switching from a vitamin K antagonist to a direct oral anticoagulant (n=111).a
Table 5. Compliance with the Global Therapeutic Positioning Report recommendations according to reason.
Table 6. Compliance with the recommendations of the Therapeutic Positioning Report according to treatment.
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Abstract
Background and objective

To evaluate the adherence to the recommendations in clinical practice performed by the Therapeutic Positioning Report (TPR) of the Spanish Agency of Medicines and Sanitary Products about the treatment with oral anticoagulants in patients aged ≥75 years old with nonvalvular atrial fibrillation (NVAF) treated in Internal Medicine departments in Spain.

Patients and methods

Observational, cross-sectional and multicenter study in which 837 patients aged ≥75 years old with NVAF, with stable treatment with oral anticoagulants at least 3 months before inclusion, and that had started treatment with oral anticoagulants before the inclusion period were included.

Results

Mean age was 83.0±5.0 years old, mean CHADS2 score 3.2±1.2, mean CHA2DS2-VASc score 5.0±1.4, and mean HAS-BLED score 2.1±0.9. A percentage of 70.8 of patients were treated with vitamin K antagonists (VKA) and the rest of patients with direct oral anticoagulants (DOACs). A percentage of 65.6 of patients treated with VKA did not follow the recommendations made by the TPR compared with 43.0% of patients treated with DOACs (p<0.0001). In the case of VKA, the main reason for being considered as not appropriate according to the TPR was having poor control of anticoagulation and not switching to DOACs, whereas in the case of DOACs, it was not receiving the adequate dose according to the TPR.

Conclusions

In a high proportion of anticoagulated elderly patients with NVAF in Spain, the recommendations performed by the TPR are not followed, particularly with VKA, since patients are not switched to DOACs despite time in therapeutic range.

Keywords:
Elderly
Vitamin K antagonists
Direct oral anticoagulants
Atrial fibrillation
Internal Medicine
Resumen
Fundamento y objetivo

Evaluar en la práctica clínica el cumplimiento de las recomendaciones del Informe de Posicionamiento Terapéutico (IPT) de la Agencia Española de Medicamentos y Productos Sanitarios sobre el tratamiento con anticoagulantes orales en pacientes ≥75 años con fibrilación auricular no valvular (FANV) atendidos en unidades de Medicina Interna en España.

Pacientes y métodos

Estudio observacional, transversal y multicéntrico, en el que se incluyeron 837 pacientes ≥75 años con FANV en tratamiento estable con anticoagulantes orales durante los 3 meses previos a la inclusión y que hubiesen iniciado dicho tratamiento antes de comenzar el período de inclusión.

Resultados

La edad media fue de 83,0±5,0 años, el CHADS2 medio 3,2±1,2, el CHA2DS2-VASc 5,0±1,4 y el HAS-BLED 2,1±0,9. El 70,8% de los pacientes estaba en tratamiento con antagonistas de la vitamina K (AVK) y el resto con anticoagulantes orales de acción directa (ACOD). El 65,6% de los pacientes con AVK no siguieron las recomendaciones del IPT frente al 43,0% de los pacientes con ACOD (p<0,0001). En el caso de los pacientes con AVK, el motivo principal para ser considerado como no adecuado fue presentar un mal control de la anticoagulación y no cambiar a un ACOD, mientras que en el caso de los ACOD fue recibir una dosis inadecuada según el IPT.

Conclusiones

En un porcentaje elevado de pacientes ancianos con FANV anticoagulados en España no se siguen las recomendaciones realizadas por el IPT, especialmente con los AVK, al no realizarse el cambio a ACOD a pesar de un tiempo en rango terapéutico inadecuado.

Palabras clave:
Anciano
Antagonistas de la vitamina K
Anticoagulantes orales de acción directa
Fibrilación auricular
Medicina Interna

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