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Incomenoy S, Saokaew S, Poonchuay N. SAMe-TT 2R 2 to Predict Clinical Outcomes and Time in Therapeutic Range in Patients on Vitamin K Antagonists: A Systematic Review and Meta-Analysis. Ann Pharmacother 2024; 58:126-139. [PMID: 37125752 DOI: 10.1177/10600280231166643] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND The SAMe-TT2R2 score identifies patients on vitamin K antagonists (VKAs) who are more likely to have poor time in therapeutic range (TTR); however, the association between SAMe-TT2R2 and clinical outcomes remains controversial. OBJECTIVES The objective is to assess the association of SAMe-TT2R2 score with clinical outcomes and poor TTR in patients on VKAs. METHODS We searched using the term "SAMe-TT2R2." Original articles reporting clinical outcomes and SAMe-TT2R2 scores before October 2021 were included. Odds ratios (ORs) of clinical outcomes, diagnostic accuracy parameters of poor TTR (<60%-70%), and mean TTR were extracted. Meta-analysis was performed using random-effects models. RESULTS Ten studies were included (N = 22 894); 4 showed pooled changes in TTR of -3.61% (95% CI:-4.88% to -2.35%) and -3.98% (95% CI: -6.08% to -1.87%) at SAMe-TT2R2 scores ≥2 and ≥3, respectively, compared with lower scores. The diagnostic accuracy parameters for poor TTR were too heterogeneous to conclude. SAMe-TT2R2 ≥3 significantly correlated with all adverse events (OR = 1.43 [95% CI: 1.29-1.54; P < 0.001]), composite thromboembolism (OR = 1.53 [95% CI: 1.19-1.97; P = 0.001]), and composite bleeding (OR = 1.33 [95% CI: 1.12-1.59; P = 0.001] regardless of the indication, while an SAMe-TT2R2 ≥2 significantly correlated with mortality (OR = 1.32 [95% CI: 1.02-1.70; P = 0.033]). We found no relationship between an SAMe-TT2R2 ≥3 and mortality or between a score ≥2 and clinical outcomes. CONCLUSIONS AND RELEVANCE Patients on VKAs with SAMe-TT2R2 ≥3 experienced more adverse events, bleeding, and thromboembolism compared with patients who had an SAMe-TT2R2 <3. However, the score had limited and inconclusive predictability for poor TTR in the study.
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Affiliation(s)
- Supatcha Incomenoy
- Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Nakhon Si Thammarat, Thailand
| | - Surasak Saokaew
- Division of Social and Administrative Pharmacy, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
- Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Natnicha Poonchuay
- Department of Pharmaceutical Care, School of Pharmacy, Walailak University, Nakhon Si Thammarat, Thailand
- Drug and Cosmetics Excellence Center, Walailak University, Nakhon Si Thammarat, Thailand
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Sánchez MA, Marín F, Masjuan J, Cosín-Sales J, Rodríguez JMV, Barrios V, Barón-Esquivias G, Lekuona I, Pérez-Cabeza AI, Freixa-Pamias R, Jimenez FJP, Khatib MMK, Priu CR, Fernández MS. Impact of heart failure on the clinical profile and outcomes in patients with atrial fibrillation treated with rivaroxaban. Data from the EMIR study. Cardiol J 2022; 29:936-947. [PMID: 36200548 PMCID: PMC9788750 DOI: 10.5603/cj.a2022.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/01/2022] [Accepted: 09/04/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The aim of this study was to analyze the impact of the presence of heart failure (HF) on the clinical profile and outcomes in patients with atrial fibrillation (AF) anticoagulated with rivaroxaban. METHODS Observational and non-interventional study that included AF adults recruited from 79 Spanish centers, anticoagulated with rivaroxaban ≥ 6 months before inclusion. Data were analyzed according to baseline HF status. RESULTS Out of 1,433 patients, 326 (22.7%) had HF at baseline. Compared to patients without HF, HF patients were older (75.3 ± 9.9 vs. 73.8 ± 9.6 years; p = 0.01), had more diabetes (36.5% vs. 24.3%; p < 0.01), coronary artery disease (28.2% vs. 12.9%; p < 0.01), renal insufficiency (31.7% vs. 22.6%; p = 0.01), higher CHA2DS2-VASc (4.5 ± 1.6 vs. 3.2 ± 1.4; p < 0.01) and HAS-BLED (1.8 ± 1.1 vs. 1.5 ± 1.0; p < 0.01). After a median follow-up of 2.5 years, among HF patients, annual rates of stroke/systemic embolism/transient ischemic attack, major adverse cardiovascular events (MACE) (non-fatal myocardial infarction, revascularization and cardiovascular death), cardiovascular death, and major bleeding were 1.2%, 3.0%, 2.0%, and 1.4%, respectively. Compared to those patients without HF, HF patients had greater annual rates of MACE (3.0% vs. 0.5%; p < 0.01) and cardiovascular death (2.0% vs. 0.2%; p < 0.01), without significant differences regarding other outcomes, including thromboembolic or bleeding events. Previous HF was an independent predictor of MACE (odds ratio 3.4; 95% confidence interval 1.6-7.3; p = 0.002) but not for thromboembolic events or major bleeding. CONCLUSIONS Among AF patients anticoagulated with rivaroxaban, HF patients had a worse clinical profile and a higher MACE risk and cardiovascular mortality. HF was independently associated with the development of MACE, but not with thromboembolic events or major bleeding.
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Affiliation(s)
- Manuel Anguita Sánchez
- Department of Cardiology, Hospital Reina Sofía Córdoba, IMIBIC, University of Cordoba, Spain
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBERCV, Murcia, Spain
| | - Jaime Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, IRYCIS, Departamento de Medicina, Universidad de Alcalá. Red INVICTUS, Madrid, Spain
| | - Juan Cosín-Sales
- Department of Cardiology, Hospital Arnau de Vilanova, Valencia, Spain
| | | | - Vivencio Barrios
- Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Alcalá University, Madrid, Spain
| | - Gonzalo Barón-Esquivias
- Department of Cardiology, Hospital Universitario Virgen del Rocio, Universidad de Sevilla, Sevilla, Spain,Unidad Cardiovascular, Instituto de Biotecnología de Sevilla, Centro de Investigación en Red Cardiovascular, Madrid, Spain
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Liyew Z, Tadesse A, Bekele N, Tsegaye T. Evaluation of Anticoagulation Control among Patients Taking Warfarin in University of Gondar Hospital, Northwest Ethiopia. Adv Hematol 2021; 2021:7530997. [PMID: 34970315 PMCID: PMC8714382 DOI: 10.1155/2021/7530997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/25/2021] [Accepted: 12/09/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Warfarin is a widely used oral anticoagulant in clinical practice. It has variable intraindividual and interindividual dose response and a narrow therapeutic index. Therefore, it requires frequent and regular international normalized ratio (INR) determination to maintain the INR within the therapeutic range. The study evaluated parameters of anticoagulation control among patients on warfarin. METHODS A cross-sectional study was conducted at University of Gondar hospital. A consecutive sampling method was used to recruit study subjects. The anticoagulation control was evaluated by determining the proportion of desired INRs and the proportion of time spent in the therapeutic range (TTR). Logistic regression analysis was used to identify associated factors with adequate TTR. A P value <0.05 was used to declare significant association. RESULT A total of 338 study subjects were included in the study. The mean age of patients was 48.8 (SD = 16.4) years. Atrial fibrillation was the commonest indication for warfarin therapy. One-third (33%) of study subjects achieved the desired INRs of 2.0-3.0, while about one-tenth (13%) of patients attained good INR control (TTR ≥ 65%). Multivariate logistic regression analysis revealed no significant association of sociodemographic and clinical characteristics with good TTR outcome. CONCLUSION The level of anticoagulation control with warfarin among study subjects was very low. The authors recommend to implement a validated warfarin-dose titration protocol and to establish anticoagulation clinics to mitigate the low anticoagulation level.
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Affiliation(s)
- Zelalem Liyew
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abilo Tadesse
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nebiyu Bekele
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Tsegaye
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Anticoagulation Control with Acenocoumarol or Warfarin in Non-Valvular Atrial Fibrillation in Primary Care (Fantas-TIC Study). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115700. [PMID: 34073370 PMCID: PMC8199061 DOI: 10.3390/ijerph18115700] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/06/2021] [Accepted: 05/18/2021] [Indexed: 12/15/2022]
Abstract
Introduction: The use of vitamin K antagonists (VKAs) in non-valvular atrial fibrillation (NVAF) is complicated due to the narrow therapeutic margin they present and their unpredictable dose–response relationship. Most studies are based on warfarin, with the results being extrapolated to acenocoumarol. However, studies comparing the two treatments in terms of the degree of anticoagulation control are scarce, justifying the present study. Main factors associated with poor control of time in therapeutic range (TTR) of anticoagulated patients are also studied. Methods: Cross-sectional study, with real-world data from patients treated in primary care (PC). Data were obtained from the System for the Improvement of Research in PC (SIDIAP) database, covering 60,978 NVAF-anticoagulated patients from 287 PC centres in 2018. Descriptive statistics were derived, and odds ratios were estimated by multivariate logistic regression. Results: 41,430 patients were considered: 93% were being treated with acenocoumarol and 7% with warfarin. There was no difference in poor control of TTR between the two types of VKA treatment, acenocoumarol and warfarin (38.9 vs. 38.4; p = 0.610). Poor anticoagulation control was mainly associated with advanced alcoholism (OR = 1.38), liver failure (OR = 1.37) and intracranial haemorrhage (OR = 1.35) as well as female sex, age < 60 years, cardiovascular history, diabetes mellitus and other variables. Conclusions: There is no association between poor anticoagulation control and the type of VKA treatment administered. Factors associated with poor control of TTR must be considered in clinical practice to improve control and decision-making.
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Mamatov SM, Kanat kyzy B, Musakeev AO, Kinderbaeva NK, Tagaev TJ. Analysis of Anticoagulant Therapy in the Elderly Patients, in Clinical Practice of Family Medicine Centers in the Kyrgyz Republic. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-03-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To study the current state of the anticoagulant's prescription in elderly and senile patients with atrial fibrillation in the clinical practice of family medicine center, in the southern regions of the Kyrgyz Republic.Material and methods. Of the 1974 ambulatory medical observation cards, 470 patients with atrial fibrillation were selected who had indications for prescribing antithrombotic therapy (87 [18.5%] men and 383 [81.5%] women; 212 [45.1%] urban residents and 258 [54.9%] rural residents). The average age was 66.9±10.2 years. The analysis included data from 387 patients who received anticoagulant therapy. The frequency of prescribing antithrombotic therapy has been studied.Results. There were indications for anticoagulant therapy in 387 patients. Anticoagulants were taken by 167 (43.2%) patients, antiplatelet agents - 196 (50.6%), no therapy - 24 (6.2%). Anticoagulant therapy in 153 patients included warfarin, while only 11.8% had adequate INR control after one year of follow-up. Rivaroxaban was prescribed in 14 (8.4%) patients. 50% of patients had antiplatelet agents instead of anticoagulants, which were mainly prescribed by therapists of rural family medicine centers.Conclusion. In the southern regions of the republic, an unfavorable situation is observed with the prescription and management of elderly and senile patients on anticoagulant therapy. It is necessary to continue the research across the country in order to obtain a complete and real picture of the problem, and to develop a unified and relevant recommendation.
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Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine. ACTA ACUST UNITED AC 2021; 57:medicina57040365. [PMID: 33918627 PMCID: PMC8069311 DOI: 10.3390/medicina57040365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/27/2021] [Accepted: 04/07/2021] [Indexed: 11/17/2022]
Abstract
Background and objectives: Patients with heart failure (HF) often present with non-valvular atrial fibrillation and require oral anticoagulation with coumarin anticoagulants such as acenocoumarol. The objective of this study was to evaluate the relationship between time in therapeutic range (TTR) and the risk of early readmission. Materials and Methods: A retrospective descriptive study was carried out on hospitalized patients with a diagnosis of HF between 2014 and 2018 who had adverse effects due to oral anticoagulation with acenocoumarol (underdosing, overdosing, or hemorrhage). Clinical, analytical, therapeutic, and prognostic variables were collected. TTR is defined as the duration of time in which the patient’s International Normalized Ratio (INR) values were within a desired range. Early readmission was defined as readmission within 30 days after hospital discharge. Patients were divided into two groups depending on whether or not they had a TTR less than 60% (TTR < 60%) over the 6 months prior to the adverse event. Results: In the cohort of 304 patients, the mean age was 82 years, 59.9% of the patients were female, and 54.6% had a TTR < 60%. Patients with TTR < 60% had a higher HAS-BLED score (4.04 vs. 2.59; p < 0.001) and INR (6 vs. 5.31; p < 0.05) but lower hemoglobin (11.67 vs. 12.22 g/dL; p < 0.05). TTR < 60% was associated with early readmission after multivariate analysis (OR: 2.05 (CI 95%: 1.16–3.61)). They also had a higher percentage of hemorrhagic events and in-hospital mortality but without reaching statistical significance. Conclusions: Patients with HF and adverse events due to acenocoumarol often have poor INR control, which is independently associated with a higher risk of early readmission.
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Chen Y, Mao M, Chang J, Yan J, Yang T, Liu Y, Luo M, Hu Y, Yang Q, Zhou L, Ma K. Safety and efficacy of new oral anticoagulants compared to those of warfarin in AF patients with cancer: a meta-analysis of randomized clinical trials and observational studies. Eur J Clin Pharmacol 2021; 77:849-857. [PMID: 33791828 DOI: 10.1007/s00228-021-03132-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/25/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Data on the efficacy and safety of nonvitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with cancer are limited. Therefore, we conducted a meta-analysis to compare the efficacy and safety between NOACs and warfarin in this population. METHODS A comprehensive search of the PubMed, Embase, and Cochrane databases for articles published through July 2020 was performed. An evaluation of each study was conducted, and data were extracted. Pooled odds ratio (OR) estimates and 95% CIs were calculated. RESULTS Eight studies (3 randomized controlled trials (RCTs) and 5 retrospective cohort studies) involving a total of 24,665 patients were included. Among the RCTs, there were no significant differences in the rates of stroke or systemic embolism (OR=0.69; 95% CI, 0.45-1.06; P=0.09), venous thromboembolism (OR=0.91; 95% CI, 0.33-2.52; P=0.86), myocardial infarction (OR=0.74; 95% CI, 0.44-1.23; P=0.24), major bleeding (OR=0.81; 95% CI, 0.61-1.06; P=0.12), or major or nonmajor clinically relevant bleeding (OR= 0.98; 95% CI, 0.82-1.19; P=0.86) between the NOAC and warfarin groups. Among the observational studies, patients who used NOACs had a significantly lower risk than those who used warfarin. The prevalence rates of ischemic stroke (OR=0.51; 95% CI, 0.28-0.92; P=0.02), VTE (OR=0.50; 95% CI, 0.41-0.60; P<0.00001), major bleeding (OR=0.28; 95% CI, 0.14-0.55; P=0.0002), and intracranial or gastrointestinal bleeding (OR=0.59; 95% CI, 0.37-0.92; P=0.02) were significantly reduced in the NOAC group. CONCLUSION Our meta-analysis confirms that NOACs are as safe and effective as warfarin and can be applied in the real world; this data can serve as a reference for clinical doctors for formulating treatment strategies.
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Affiliation(s)
- Yueming Chen
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Min Mao
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Chang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Yan
- Department of Cardiology, The General Hospital of Chongqing Iron and Steel Group, Chongqing, China
| | - Tiantian Yang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Liu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Meng Luo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuhao Hu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Yang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Zhou
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kanghua Ma
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Dalmau Llorca MR, Aguilar Martín C, Carrasco-Querol N, Hernández Rojas Z, Forcadell Drago E, Rodríguez Cumplido D, Pepió Vilaubí JM, Castro Blanco E, Gonçalves AQ, Fernández-Sáez J. Oral Anticoagulant Adequacy in Non-Valvular Atrial Fibrillation in Primary Care: A Cross-Sectional Study Using Real-World Data (Fantas-TIC Study). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052244. [PMID: 33668315 PMCID: PMC7956646 DOI: 10.3390/ijerph18052244] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/21/2022]
Abstract
Background: Oral anticoagulants (OAs) are the treatment to prevent stroke in atrial fibrillation (AF). Anticoagulant treatment choice in non-valvular atrial fibrillation (NVAF) must be individualized, taking current guidelines into account. Adequacy of anticoagulant therapy under the current criteria for NVAF in real-world primary care is presented. Methods: Cross-sectional study, with real-world data from patients treated in primary care (PC). Data were obtained from the System for the Improvement of Research in Primary Care (SIDIAP) database, covering 60,978 NVAF-anticoagulated patients from 287 PC centers in 2018. Results: In total, 41,430 (68%) were treated with vitamin K antagonists (VKAs) and 19,548 (32%) NVAF with direct-acting oral anticoagulants (DOACs). Inadequate prescription was estimated to be 36.0% and 67.6%, respectively. Most DOAC inadequacy (77.3%) was due to it being prescribed as a first-line anticoagulant when there was no history of thromboembolic events or intracranial hemorrhage (ICH). A total of 22.1% had missing estimated glomerular filtration rate (eGFR) values. Common causes of inadequate VKA prescription were poor control of time in therapeutic range (TTR) (98.8%) and ICH (2.2%). Conclusions: Poor adequacy to current criteria was observed, being inadequacy higher in DOACs than in VKAs. TTR and GFR should be routinely calculated in electronic health records (EHR) to facilitate decision-making and patient safety.
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Affiliation(s)
- M. Rosa Dalmau Llorca
- Equip d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain; (M.R.D.L.); (Z.H.R.); (E.F.D.); (J.M.P.V.)
- Grupo GAVINA, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Tortosa, 43500 Tarragona, Spain;
- GAVINA Research Group, Tortosa, 43500 Tarragona, Spain; (C.A.M.); (A.Q.G.); (J.F.-S.); (D.R.C.)
| | - Carina Aguilar Martín
- GAVINA Research Group, Tortosa, 43500 Tarragona, Spain; (C.A.M.); (A.Q.G.); (J.F.-S.); (D.R.C.)
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, 43500 Tarragona, Spain
- Unitat d’Avaluació, Direcció d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain
| | - Noèlia Carrasco-Querol
- GAVINA Research Group, Tortosa, 43500 Tarragona, Spain; (C.A.M.); (A.Q.G.); (J.F.-S.); (D.R.C.)
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, 43500 Tarragona, Spain
- Correspondence:
| | - Zojaina Hernández Rojas
- Equip d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain; (M.R.D.L.); (Z.H.R.); (E.F.D.); (J.M.P.V.)
- Grupo GAVINA, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Tortosa, 43500 Tarragona, Spain;
- GAVINA Research Group, Tortosa, 43500 Tarragona, Spain; (C.A.M.); (A.Q.G.); (J.F.-S.); (D.R.C.)
| | - Emma Forcadell Drago
- Equip d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain; (M.R.D.L.); (Z.H.R.); (E.F.D.); (J.M.P.V.)
- GAVINA Research Group, Tortosa, 43500 Tarragona, Spain; (C.A.M.); (A.Q.G.); (J.F.-S.); (D.R.C.)
| | - Dolores Rodríguez Cumplido
- GAVINA Research Group, Tortosa, 43500 Tarragona, Spain; (C.A.M.); (A.Q.G.); (J.F.-S.); (D.R.C.)
- Hospital Universitari de Bellvitge, Institut Català de la Salut, 08907 Barcelona, Spain
| | - Josep M. Pepió Vilaubí
- Equip d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain; (M.R.D.L.); (Z.H.R.); (E.F.D.); (J.M.P.V.)
- GAVINA Research Group, Tortosa, 43500 Tarragona, Spain; (C.A.M.); (A.Q.G.); (J.F.-S.); (D.R.C.)
| | - Elisabet Castro Blanco
- Grupo GAVINA, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Tortosa, 43500 Tarragona, Spain;
- GAVINA Research Group, Tortosa, 43500 Tarragona, Spain; (C.A.M.); (A.Q.G.); (J.F.-S.); (D.R.C.)
| | - Alessandra Q. Gonçalves
- GAVINA Research Group, Tortosa, 43500 Tarragona, Spain; (C.A.M.); (A.Q.G.); (J.F.-S.); (D.R.C.)
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, 43500 Tarragona, Spain
- Unitat Docent de Medicina de Familia i Comunitària, Tortosa-Terres de l’Ebre, Institut Català de la Salut, Tortosa, 43500 Tarragona, Spain
| | - José Fernández-Sáez
- Grupo GAVINA, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Tortosa, 43500 Tarragona, Spain;
- GAVINA Research Group, Tortosa, 43500 Tarragona, Spain; (C.A.M.); (A.Q.G.); (J.F.-S.); (D.R.C.)
- Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, 43500 Tarragona, Spain
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Ginel-Mendoza L, Hidalgo-Natera A, Reina-Gonzalez R, Poyato-Ramos R, Morales-Naranjo J, Lupiañez-Pérez I, Baca-Osorio A, Gutiérrez-Jansen M, Fernández-Lara MP, Lozano-Noriega D, Salgado-Carvallo U, Bandera-García C, Navarro-Moya FJ. Efficacy of a joint didactic intervention using the Junta De Andalucía School for Patients method to control prothrombin time in patients taking anticoagulants: protocol for a randomized controlled trial. Trials 2021; 22:45. [PMID: 33430922 PMCID: PMC7798294 DOI: 10.1186/s13063-020-04972-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 12/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oral anticoagulant drugs represent an essential tool in the prevention of thromboembolic events. The ones in widespread use are vitamin K antagonists, whose plasma level is monitored by measuring prothrombin time using the international normalized ratio. If its values are out of the recommended range, the patient will have a higher risk of suffering from thromboembolic or hemorrhagic complications. Previous research has shown that approximately 33% of patients keep having values at an inappropriate level. The purpose of the proposed study is to improve the international normalized ratio control results by a joint didactic intervention based on the Junta de Andalucía School for Patients method that will be implemented by anticoagulated patients themselves. METHODS A randomized controlled trial will be undertaken at primary care centers from one healthcare area in Málaga (Andalusia, Spain). STUDY POPULATION patients participating in an oral anticoagulant therapy program of vitamin K antagonists. First step: identification of patients in the oral anticoagulation therapy program with international normalized ratio control of the therapeutic level at 65% or less over total time. Second step: patients with international normalized ratio (INR) control figures under 2 or above 3 will be assigned to two different groups: Group 1 or joint intervention group: patients will be instructed in the joint didactic "from peer to peer," by a previously trained and expert anticoagulant patient. Group 2 or control group: the control group will receive the usual clinical practice. They will be evaluated by nurses about once a month, except for cases in which their INR figures are under 2 or above 3, and those patients will be evaluated more frequently. A total of 312 individuals will be required (156 in each group) to detect differences in INR figures equal to or higher than 15% between the groups. STUDY VARIABLES time on therapeutic levels before and after the intervention; sociodemographic variables; vital signs; the existence of cardiovascular risk factors or accompanying diseases in the clinical records; laboratory test including complete blood counts, bleeding time, and prothrombin time or partial thromboplastin time; and blood chemistry, other prescribed drugs, and social support. A quasi-experimental analytic study with before-after statistical analysis of the intervention will be conducted. Linear regression models will be applied for the main variable results (international normalized ratio value, time on therapeutic level) inputting sociodemographic variables, accompanying diseases, and social support. TRIAL REGISTRATION ClinicalTrials.gov NCT03647254 . Registered on 27 August 2018.
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Affiliation(s)
- Leovigildo Ginel-Mendoza
- Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, C/ Sancho Miranda 9, 29014, Málaga, Spain.
| | - Alfonso Hidalgo-Natera
- Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, C/ Sancho Miranda 9, 29014, Málaga, Spain
| | - Rocío Reina-Gonzalez
- Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, C/ Sancho Miranda 9, 29014, Málaga, Spain
| | - Rafael Poyato-Ramos
- Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, C/ Sancho Miranda 9, 29014, Málaga, Spain
| | - Juana Morales-Naranjo
- Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, C/ Sancho Miranda 9, 29014, Málaga, Spain
| | - Inmaculada Lupiañez-Pérez
- Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, C/ Sancho Miranda 9, 29014, Málaga, Spain
| | - Antonio Baca-Osorio
- Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, C/ Sancho Miranda 9, 29014, Málaga, Spain
| | - Miguel Gutiérrez-Jansen
- Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, C/ Sancho Miranda 9, 29014, Málaga, Spain
| | - María Paz Fernández-Lara
- Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, C/ Sancho Miranda 9, 29014, Málaga, Spain
| | - Diego Lozano-Noriega
- Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, C/ Sancho Miranda 9, 29014, Málaga, Spain
| | - Ulises Salgado-Carvallo
- Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, C/ Sancho Miranda 9, 29014, Málaga, Spain
| | - Cristina Bandera-García
- Centro de Salud Ciudad Jardín, Distrito Sanitario Málaga-Guadalhorce, C/ Sancho Miranda 9, 29014, Málaga, Spain
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Escobar C, Borrás X, Bover Freire R, González-Juanatey C, Morillas M, Muñoz AV, Gómez-Doblas JJ. A Delphi consensus on the management of oral anticoagulation in patients with non-valvular atrial fibrillation in Spain: ACOPREFERENCE study. PLoS One 2020; 15:e0231565. [PMID: 32479502 PMCID: PMC7263623 DOI: 10.1371/journal.pone.0231565] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 03/26/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the level of agreement between cardiologists regarding the management of oral anticoagulation (OAC) in patients with non-valvular atrial fibrillation (NVAF) in Spain. MATERIALS AND METHODS A two-round Delphi study was performed using an online survey. In round 1, panel members rated their level of agreement with the questionnaire items on a 9-point Likert scale. Item selection was based on acceptance by ≥66.6% of panellists and the agreement of the scientific committee. In round 2, the same panellists evaluated those items that did not meet consensus in round 1. RESULTS A total of 238 experts participated in round 1; of these, 217 completed the round 2 survey. In round 1, 111 items from 4 dimensions (Thromboembolic and bleeding risk evaluation for treatment decision-making: 18 items; Choice of OAC: 39 items; OAC in specific cardiology situations: 12 items; Patient participation and education: 42 items) were evaluated. Consensus was reached for 92 items (83%). Over 80% of the experts agreed with the use of DOACs as the initial anticoagulant treatment when OAC is indicated. Panellists recommended the use of DOACs in patients at high risk of thromboembolic complications (CHA2DS2-VASc ≥3) (83%), haemorrhages (HAS-BLED ≥3) (89%) and poor quality of anticoagulation control (SAMe-TT2R2 >2) (76%), patients who fail to achieve an optimal therapeutic range after 3 months on VKA treatment (93%), and those who are to undergo cardioversion (80%). Panellists agreed that the efficacy and safety profile of each DOAC (98%), the availability of a specific reversal agent (72%) and patient's preference (85%) should be considered when prescribing a DOAC. A total of 97 items were ultimately accepted after round 2. CONCLUSIONS This Delphi panel study provides expert-based recommendations that may offer guidance on clinical decision-making for the management of OAC in NVAF. The importance of patient education and involvement has been highlighted.
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Affiliation(s)
- Carlos Escobar
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
- * E-mail:
| | - Xavier Borrás
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ramón Bover Freire
- Cardiology Department, Hospital Clínico San Carlos, CIBERCV, Madrid, Spain
| | | | - Miren Morillas
- Cardiology Department, Hospital de Galdakao, Galdakao, Bizkaia, Spain
| | | | - Juan José Gómez-Doblas
- Cardiology Department, Hospital Universitario Virgen de la Victoria, CIBERCV, Málaga, Spain
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11
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Anguita M, de la Figuera M, Cabeza AIP, Fernández CS. Clinical profile and management of rivaroxaban in patients with atrial fibrillation in routine practice in Spain: data from six nationwide studies. Drugs Context 2019; 8:212606. [PMID: 31692949 PMCID: PMC6822684 DOI: 10.7573/dic.212606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 11/21/2022] Open
Abstract
AIMS To analyze the clinical profile and management of patients with nonvalvular atrial fibrillation taking rivaroxaban in routine practice in Spain. METHODS Clinical data from the observational studies HEROIC (cardiology and hematology; n=1,727), EMIR (cardiology; n=1,493), BRONCE-AP (primary care; n=133), SILVER-AP (primary care; n=457), ALADIN (internal medicine and neurology; n=249), and ESPARTA (internal medicine; n=110) of patients taking rivaroxaban were analyzed. The clinical profile was compared with those of the XANTUS and ROCKET-AF studies. RESULTS Overall, mean age was 74.9±9.4 years, CHA2DS2-VASc score was 3.7±1.5, and 43.2% had a HAS-BLED score ≥3. Patients included in the HEROIC and EMIR studies were older and more frequently had a creatinine clearance <50 mL/min and a higher thromboembolic risk than those in the XANTUS study, and patients included in the ALADIN study were older and had more prior cerebrovascular disease, but a lower thromboembolic risk than those in the ROCKET-AF trial. In those studies with available data, medication adherence and satisfaction with rivaroxaban were high. CONCLUSION Bearing in mind differences according to the clinical setting of each study, atrial fibrillation patients taking rivaroxaban in Spain were elderly and had a high thromboembolic risk. Medication adherence and satisfaction with rivaroxaban were high.
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Affiliation(s)
- Manuel Anguita
- Cardiology Department, Hospital Universitario Reina Sofia, Córdoba, Spain
| | | | | | - Carmen Suarez Fernández
- Internal Medicine Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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12
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[Making balances between the risks and benefits of pharmacological treatment in dementia, chronic pain and anticoagulation in elderly persons]. Aten Primaria 2019; 50 Suppl 2:39-50. [PMID: 30563624 PMCID: PMC6836956 DOI: 10.1016/j.aprim.2018.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/19/2018] [Accepted: 09/05/2018] [Indexed: 11/20/2022] Open
Abstract
En la demencia los fármacos específicos y psicofármacos utilizados para síntomas psicóticos y de conducta tienen eficacia limitada. Los efectos adversos pueden ser importantes dada edad y comorbilidad de los pacientes. Es necesario, frecuentemente, su retirada, planificada conjuntamente con familiares, monitorizando la respuesta y ofreciendo alternativas de tratamiento no farmacológicas. El dolor crónico lo sufren el 25-76% de los ancianos que viven en comunidad y es más frecuente en mujeres. El tratamiento es multidisciplinar, estableciendo objetivos realistas, individualizándolo, iniciando con dosis menores los fármacos y reevaluando continuamente para controlar efectos secundarios y lograr el nivel de analgesia correcto. La prevalencia de fibrilación auricular (FA) aumenta con la edad y está infradiagnosticada. Se recomienda anticoagulación oral con dicumarínicos o anticoagulantes orales directos no antagonistas de la vitamina K, en pacientes con FA mayores de 65 años salvo contraindicación, para reducir el riesgo embólico, confirmando los análisis de subgrupos eficacia similar en prevención de ACV.
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13
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García-Sempere A, Hurtado I, Bejarano-Quisoboni D, Rodríguez-Bernal C, Santa-Ana Y, Peiró S, Sanfélix-Gimeno G. Quality of INR control and switching to non-Vitamin K oral anticoagulants between women and men with atrial fibrillation treated with Vitamin K Antagonists in Spain. A population-based, real-world study. PLoS One 2019; 14:e0211681. [PMID: 30753227 PMCID: PMC6372152 DOI: 10.1371/journal.pone.0211681] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/20/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Worldwide, there is growing evidence that quality of international normalized ratio (INR) control in atrial fibrillation patients treated with Vitamin K Antagonists (VKA) is suboptimal. However, sex disparities in population-based real-world settings have been scarcely studied, as well as patterns of switching to second-line Non-VKA oral anticoagulants (NOAC). We aimed to assess the quality of INR control in atrial fibrillation patients treated with VKA in the region of Valencia, Spain, for the whole population and differencing by sex, and to identify factors associated with poor control. We also quantified switching to Non-VKA oral anticoagulants (NOAC) and we identified factors associated to switching. METHODS This is a cross-sectional, population-based study. Information was obtained through linking different regional electronic databases. Outcome measures were Time in Therapeutic Range (TTR) and percentage of INR determinations in range (PINRR) in 2015, and percentage of switching to NOAC in 2016, for the whole population and stratified by sex. RESULTS We included 22,629 patients, 50.4% were women. Mean TTR was 62.3% for women and 63.7% for men, and PINNR was 58.3% for women and 60.1% for men (p<0.001). Considering the TTR<65% threshold, 53% of women and 49.3% of men had poor anticoagulation control (p<0.001). Women, long-term users antiplatelet users, and patients with comorbidities, visits to Emergency Department and use of alcohol were more likely to present poor INR control. 5.4% of poorly controlled patients during 2015 switched to a NOAC throughout 2016, with no sex differences. CONCLUSION The quality of INR control of all AF patients treated with VKA in 2015 in our Southern European region was suboptimal, and women were at a higher risk of poor INR control. This reflects sex disparities in care, and programs for improving the quality of oral anticoagulation should incorporate the gender perspective. Clinical inertia may be lying behind the observed low rates of switching in patient with poor INR control.
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Affiliation(s)
- Aníbal García-Sempere
- Health Services Research Unit, Foundation for Biomedical Research of Valencia—FISABIO, Valencia, Spain
| | - Isabel Hurtado
- Health Services Research Unit, Foundation for Biomedical Research of Valencia—FISABIO, Valencia, Spain
| | - Daniel Bejarano-Quisoboni
- Health Services Research Unit, Foundation for Biomedical Research of Valencia—FISABIO, Valencia, Spain
| | - Clara Rodríguez-Bernal
- Health Services Research Unit, Foundation for Biomedical Research of Valencia—FISABIO, Valencia, Spain
| | - Yared Santa-Ana
- Health Services Research Unit, Foundation for Biomedical Research of Valencia—FISABIO, Valencia, Spain
| | - Salvador Peiró
- Health Services Research Unit, Foundation for Biomedical Research of Valencia—FISABIO, Valencia, Spain
| | - Gabriel Sanfélix-Gimeno
- Health Services Research Unit, Foundation for Biomedical Research of Valencia—FISABIO, Valencia, Spain
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14
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Wasniewski S, Consuegra-Sánchez L, Conesa-Zamora P, García de Guadiana-Romualdo L, Ramos-Ruiz P, Merelo-Nicolás M, Clavel-Ruipérez FG, Alburquerque-González B, Soria-Arcos F, Castillo-Moreno JA. Low Performance of a Clinical-Genetic Model in the Estimation of Time in Therapeutic Range in Acenocoumarol-Adherent Patients with Nonvalvular Atrial Fibrillation: The Quality of Anticoagulation Challenge. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8012747. [PMID: 30417015 PMCID: PMC6207892 DOI: 10.1155/2018/8012747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/01/2018] [Accepted: 09/20/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Anticoagulation with vitamin K antagonists continues to be a challenging task given the difficulty of achieving a correct time in therapeutic range (TTR). The SAMeTT2R2 score has been proposed to identify patients that will be good responders. In this study we aimed to analyse clinical and genetic factors involved in a correct level of anticoagulation in patients with atrial fibrillation and thereby potentially improve the diagnostic performance of SAMeTT2R2 score. METHODS We prospectively included 212 consecutive patients with nonvalvular atrial fibrillation under treatment with acenocoumarol for at least 6 months that were attended in a cardiology outpatient clinic and were categorized as adherent to medication. We carried out a multivariate regression analysis to detect the independent predictive factors of good control. In all patients VKORC1, CYP2C9⁎2, CYP2C9⁎3, and MIR133A2 genotyping was performed. RESULTS A total of 128 (60.4%) patients presented TTR <70% (average TTR = 63.2). We identified body mass index (OR 0.94, 95%CI 0.89-0.99, p=0.032) and regular vitamin K intake (OR 0.53, 95%CI 0.28-0.99, p= 0.046) as independent predictors of poor anticoagulation control. The discriminatory power of a clinical-genetic model derived from our cohort was significantly better compared to the SAMeTT2R2 score (C-statistic 0.658 versus 0.524, p<0.001). CONCLUSIONS In our study the SAMeTT2R2 score revealed a poor ability in the prediction of TTR. Besides SAMeTT2R2, body mass index and possibly vitamin K intake should be taken into account when deciding the optimal anticoagulation strategy. The information provided by the identified genotypes was marginal.
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Affiliation(s)
- Samantha Wasniewski
- Department of Cardiology, Santa Lucía General University Hospital, Cartagena-Murcia, Spain
| | | | - Pablo Conesa-Zamora
- Department of Clinical Analysis, Santa Lucía General University Hospital, Cartagena-Murcia, Spain
| | | | - Pablo Ramos-Ruiz
- Department of Cardiology, Santa Lucía General University Hospital, Cartagena-Murcia, Spain
| | - Marta Merelo-Nicolás
- Department of Cardiology, Santa Lucía General University Hospital, Cartagena-Murcia, Spain
| | | | | | - Federico Soria-Arcos
- Department of Cardiology, Santa Lucía General University Hospital, Cartagena-Murcia, Spain
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15
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Suárez Fernández C, Castilla-Guerra L, Cantero Hinojosa J, Suriñach JM, Acosta de Bilbao F, Tamarit JJ, Diaz Diaz JL, Hernandez JL, Pose A, Montero-Pérez-Barquero M, Roquer J, Gállego J, Vivancos J, Mostaza JM. Satisfaction with oral anticoagulants in patients with atrial fibrillation. Patient Prefer Adherence 2018; 12:267-274. [PMID: 29497282 PMCID: PMC5822854 DOI: 10.2147/ppa.s152109] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Although, by itself, atrial fibrillation is associated with an impairment of quality of life antithrombotic therapy may play a role. OBJECTIVE To evaluate the satisfaction with anticoagulant treatment in patients with nonvalvular atrial fibrillation who attended internal medicine departments in Spain. METHODS Patients 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. RESULTS A 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). CONCLUSION Satisfaction 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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Affiliation(s)
| | | | | | | | - Fernando Acosta de Bilbao
- Internal Medicine Service, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria
| | | | - José Luis Diaz Diaz
- Internal Medicine Service, Complejo Universitario Hospitalario de A Coruña, La Coruña
| | - Jose Luis Hernandez
- Internal Medicine Service, Hospital Marqués de Valdecilla, Universidad de Cantabria, Santander
| | - Antonio Pose
- Internal Medicine Service, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela
| | - Manuel Montero-Pérez-Barquero
- Internal Medicine Service, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Reina Sofía, Universidad de Córdoba, Córdoba
| | | | - Jaime Gállego
- Neurology Service, Complejo Hospitalario de Navarra, Pamplona, Navarra
| | - José Vivancos
- Neurology Service, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid
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Boned-Ombuena A, Pérez-Panadés J, López-Maside A, Miralles-Espí M, Guardiola Vilarroig S, Adam Ruiz D, Zurriaga O. [Prevalence of oral anticoagulation and quality of its management in primary healthcare: A study by the Health Sentinel Network of the Region of Valencia (Spain)]. Aten Primaria 2017; 49:534-548. [PMID: 28408116 PMCID: PMC6876010 DOI: 10.1016/j.aprim.2016.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/15/2016] [Accepted: 11/09/2016] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of patients with oral anticoagulant therapy (OAT) in the Region of Valencia and to evaluate the quality of management of OAT with vitaminK antagonists (VKA) carried out in primary healthcare. DESIGN Observational cross-sectional study conducted through the Health Sentinel Network of the Region of Valencia, which includes a survey and the retrospective analysis of OAT monitoring. SETTING Primary healthcare, Region of Valencia, Spain. SUBJECTS All patients aged 18years or older on OAT who consulted during the year 2014. The population covered by the 59 doctors of the Health Sentinel Network constitutes 2.2% of the adult population of the Region of Valencia, and it is representative of it. KEY MEASUREMENTS Demographic, socioeconomic and health data as well as information concerning OAT. Quality of OAT management with VKA was assessed by means of the percentage of time in therapeutic range (TTR), computed using the Rosendaal method. RESULTS A total of 1,144 patients were recorded (mean age 74.5±11 years; 49.7% women). Prevalence of OAT in the Region of Valencia is 1.3 cases per 100 population. The characteristic profile of these patients is an old person, with several comorbidities and a low level of education, who lives accompanied. Atrial fibrillation is the most common indication. 82.8% of patients on OAT with VKA were monitored in primary healthcare. The average TTR was 65.0%, and 53.9% of patients had a TTR ≥65%. Among inadequately controlled patients, 74.4% were perceived as well-controlled by their primary care doctor. CONCLUSIONS Prevalence of OAT is high, and it is expected to increase. The degree of control achieved meets the generally accepted quality standard (mean TTR ≥65%), and it is comparable to that observed in other national and international studies. However, there is wide scope for improvement. It is crucial to optimize the management of this therapy in the most effective and cost-effective way. Among other measures, access of physicians to their patients' clinical information should be improved.
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Affiliation(s)
- Ana Boned-Ombuena
- Departamento de Salud Valencia La Fe, Conselleria de Sanitat Universal i Salut Pública de la Comunitat Valenciana, Valencia, España.
| | - Jordi Pérez-Panadés
- Dirección General de Salud Pública, Conselleria de Sanitat Universal i Salut Pública de la Comunitat Valenciana, Valencia, España
| | - Aurora López-Maside
- Dirección General de Salud Pública, Conselleria de Sanitat Universal i Salut Pública de la Comunitat Valenciana, Valencia, España
| | - Maite Miralles-Espí
- Dirección General de Salud Pública, Conselleria de Sanitat Universal i Salut Pública de la Comunitat Valenciana, Valencia, España
| | - Sandra Guardiola Vilarroig
- Dirección General de Salud Pública, Conselleria de Sanitat Universal i Salut Pública de la Comunitat Valenciana, Valencia, España
| | - Desamparados Adam Ruiz
- Centro de Salud Salvador Allende, Conselleria de Sanitat Universal i Salut Pública de la Comunitat Valenciana, Valencia, España
| | - Oscar Zurriaga
- Dirección General de Salud Pública, Conselleria de Sanitat Universal i Salut Pública de la Comunitat Valenciana, Valencia, España; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, España
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de la Figuera M, Cinza S, Marín N, Egocheaga I, Prieto MA. [Clinical characteristics of patients with atrial fibrillation treated with direct oral anticoagulants attended in primary care setting. The SILVER-AP study]. Aten Primaria 2017; 50:359-367. [PMID: 28764897 PMCID: PMC6839200 DOI: 10.1016/j.aprim.2017.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/30/2017] [Indexed: 01/06/2023] Open
Abstract
Objetivo Describir las características clínicas y el manejo de pacientes con fibrilación auricular no valvular (FANV) tratados con anticoagulantes orales de acción directa (ACOD). Diseño Estudio observacional, transversal y multicéntrico. Emplazamiento Comunidades autónomas en las que el médico de atención primaria puede prescribir ACOD (n = 9). Participantes Un total de 790 pacientes con riesgo de ictus o embolia sistémica que estuviesen en tratamiento crónico con anticoagulantes, que hubiesen modificado su pauta terapéutica, y que actualmente estuviesen en tratamiento con un ACOD durante al menos 3 meses. Mediciones principales Recogida de datos sociodemográficos y de manejo clínico. Resultados La edad media de los sujetos fue de 78,6 ± 8,4 años; un 50,5% eran varones; CHADS2: 2,6 ± 1,2; CHA2DS2-VASc: 4,3 ± 1,6; HAS-BLED: 2,3 ± 1,0. La duración media del tratamiento con ACOD fue de 15,8 ± 12,5 meses. El ACOD más frecuentemente prescrito fue rivaroxabán (57,8%), seguido de dabigatrán (23,7%) y apixabán (18,5%). De los pacientes que tomaban rivaroxabán, el 70,2% recibieron la dosis de 20 mg/día. En el caso de dabigatrán, el 41,7% tomaban la dosis de 150 mg/12 h, y con respecto a apixabán, el 56,2% tomaban la dosis de 5 mg/12 h. La satisfacción con el tratamiento con ACOD (cuestionario ACTS: 52,0 ± 7,2 puntos en la escala Carga y 12,1 ± 2,2 puntos en la escala Beneficio) y el cumplimiento (97,8% de los pacientes fueron cumplidores) fueron elevados. Conclusiones Los pacientes en tratamiento con ACOD en España tienen un elevado riesgo tromboembólico. Una proporción significativa de sujetos reciben una dosis menor de ACOD de la que les correspondería por sus características clínicas. La satisfacción y la adherencia son elevadas.
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Affiliation(s)
| | - Sergio Cinza
- Centro de Saúde (CS) Porto do Son, Santiago de Compostela, España
| | - Nuria Marín
- Bayer Hispania S.L., General Medicine CV, Barcelona, España.
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