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Original article
Mortality in a cohort of primary care patients treated with vitamin K antagonist anticoagulants
Mortalidad en una cohorte de pacientes de Atención Primaria tratados con anticoagulantes antagonistas de la vitamina K
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David Martín Enguixa,
Corresponding author
davidm123m45@hotmail.com

Corresponding author.
, Juan Carlos Aguirre Rodrígueza, Abraham Hidalgo Rodríguezb
a Medicina Familiar y Comunitaria, Centro de Salud Fortuny Velutti, Distrito Sanitario Granada Metropolitano, Granada, Spain
b Medicina Familiar y Comunitaria, Centro de Salud Casería de Montijo, Distrito Sanitario Granada Metropolitano, Granada, Spain
Received 25 April 2020. Accepted 09 July 2020
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Tables (3)
Table 1. Main characteristics of the patients at the beginning of the study.
Table 2. Variables related to mortality during follow-up.
Table 3. Multivariate analysis of variables related to mortality.
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Abstract
Introduction and objectives

The use of anticoagulants to prevent embolic events in Spain is very high, tending to a progressive increase. For this reason, we intend to analyse the mortality of patients from a metropolitan area of ​​Granada treated with vitamin K antagonist anticoagulants (VKA), over 2 non-consecutive years.

Patients and methods

Longitudinal, observational, retrospective study of 205 patients treated with AVK. Sociodemographic data, previous clinical conditions, pathology causing AVK treatment, degree of control and mortality were collected 2 years after the start of the study.

Results

Average age, 76 ± 11.8 years (57.56% women). Two-year mortality was 22.4%, with a significant increase depending on age (p < .001) and years of treatment (p < .001). Patients with dementia (p < .05), with chronic kidney disease (p < .01) or with chronic obstructive pulmonary disease (p < .01) also presented higher mortality. Multivariate analysis showed significant effect of chronic kidney disease (odds ratio = 4.075), chronic obstructive pulmonary disease (odds ratio = 3.694), and years of treatment (odds ratio = 1.236).

Conclusions

At 2 years of follow-up, 1 in 5 patients treated with VKA died. The presence of chronic kidney disease, chronic obstructive pulmonary disease and a longer treatment time were independently associated with this increase of mortality. Most of the patients were anticoagulated by atrial fibrillation, they were elderly and had a high prevalence of comorbidities.

Keywords:
Vitamin K antagonists
Primary Care
Mortality
Oral anticoagulant treatment
Resumen
Introducción y objetivos

El uso de anticoagulantes para prevenir eventos embólicos en España es muy elevado, tendiendo a un aumento progresivo. Por ello pretendemos analizar la mortalidad de los pacientes tratados con anticoagulantes antagonistas de la vitamina K (AVK) de un área metropolitana de Granada, en 2 años no consecutivos.

Pacientes y métodos

Estudio longitudinal, observacional, retrospectivo de 205 pacientes tratados con AVK. Se recogieron datos sociodemográficos, condiciones clínicas previas, patología causante del tratamiento AVK, grado de control y la mortalidad a 2 años del inicio del estudio.

Resultados

Edad media, 76 ± 11,8 años (57,56% mujeres). La mortalidad a los dos años fue del 22,4%, con un aumento significativo en función de la edad (p < 0,001) y los años de tratamiento (p < 0,001). Los pacientes con demencia (p < 0,05), con enfermedad renal crónica (p < 0,01) o con enfermedad pulmonar obstructiva crónica (p < 0,01) presentaron también mayor mortalidad. El análisis multivariante demostró efecto significativo de la enfermedad renal crónica (odds ratio = 4,075), la enfermedad pulmonar obstructiva crónica (odds ratio = 3,694) y los años de tratamiento (odds ratio = 1,236).

Conclusiones

A los 2 años de seguimiento, fallecieron 1 de cada 5 pacientes tratados con AVK y se asociaron independientemente a este aumento la presencia de enfermedad renal crónica, enfermedad pulmonar obstructiva crónica y un mayor tiempo de tratamiento. La mayoría de los pacientes estaban anticoagulados por una fibrilación auricular, tenían una edad avanzada y una alta prevalencia de comorbilidades.

Palabras clave:
Antagonistas de la vitamina K
Atención Primaria
Mortalidad
Tratamiento anticoagulante oral

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