scholarly journals Adherence to the 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline on the Use of Oral Anticoagulant Agents in Middle Eastern Patients with Atrial Fibrillation: The Jordan Atrial Fibrillation (JoFib) Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Ayman J. Hammoudeh ◽  
Yousef Khader ◽  
Nazih Kadri ◽  
Eyas Al-Mousa ◽  
Yahya Badaineh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Oral Anticoagulant ◽  
Vitamin K Antagonists ◽  
Middle Eastern ◽  
Outpatient Clinics ◽  
Current Status ◽  
Anticoagulant Agents ◽  
Systemic Embolization ◽  
Clinical Profiles

Background. There is a scarcity of studies that evaluate adherence to the utilization of guideline-recommended oral anticoagulant agents (OACs) in patients with atrial fibrillation (AF) in the Middle East. The Jordan Atrial Fibrillation (JoFib) Study evaluated baseline clinical profiles and the utilization of OACs, including vitamin K antagonists (VKAs) and direct OACs (DOACs), in patients with valvular AF (VAF) and nonvalvular AF (NVAF) according to the 2019 focused update of the 2014 AHA/ACC/HRS guidelines. Methods. Consecutive patients with AF were enrolled in 29 hospitals and outpatient clinics. The use of OACs was evaluated in patients with VAF and NVAF according to the prespecified guideline. Results. Of 2000 patients, 177 (8.9%) had VAF and 1823 (91.1%) had NVAF. A VKA was prescribed for 88.1% of the VAF group. In the NVAF group, 1468 (80.5%) of patients had a high CHA2DS2-VASc score, i.e., a score of ≥3 in women and ≥2 in men; 202 (11.1%) patients had an intermediate CHA2DS2-VASc score, i.e., a score of 2 in women and 1 in men; and 153 (8.4%) patients had a low CHA2DS2-VASc score, i.e., a score of 1 in women and 0 in men. Of patients with a high CHA2DS2-VASc score, 1204 (82.0%) received OACs, including DOACs for 784 (53.4%) and VKA for 420 (28.6%) patients. Among patients with an intermediate score, OACs were prescribed for 148 (73.3%) patients, including 107 (53.0%) who received DOACs and 41 (20.3%) patients who received VKA. In patients with a low score, OACs were omitted in 94 (61.4%) patients and prescribed for 59 (38.6%) patients. Multivariate analysis showed that age between 50 and 70 years, CHA2DS2-VASc score of ≥2, a diagnosis of stroke or systemic embolization, and nonparoxysmal AF were significantly associated with increased odds of OAC prescription. Conclusions. The current status of the utilization of OACs in Middle Eastern AF patients appears to be promising and is consistent with the 2019 focused update of the 2014 AHA/ACC/HRS guideline. This trial is registered with NCT03917992.

scholarly journals Women with atrial fibrillation in the Middle East: utilization of oral anticoagulant agents in a population with bad baseline clinical profiles and risk scores

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Hammoudeh ◽  
R Ibdah ◽  
S Rawashdeh ◽  
A Ababneh ◽  
A Al-Kasasbeh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Middle East ◽  
Risk Score ◽  
Oral Anticoagulant ◽  
Middle Eastern ◽  
Risk Scores ◽  
Funding Sources ◽  
Middle Eastern Women ◽  
Anticoagulant Agents ◽  
Artery Disease

Abstract Background Atrial fibrillation (AF) is the most common sustained arrhythmia in women and men worldwide and in the Middle East. Several studies have shown that women with AF are undertreated despite worse baseline clinical and risk profiles compared with men. It is largely unknown if this also applies to Middle Eastern AF patients. Purpose To evaluate baseline clinical features and utilization of guideline-recommended oral anticoagulant medications (OACs) in Middle Eastern women with AF. Methods The Jordan AF prospective multicenter study enrolled 2160 patients with AF, including 1164 (53.9%) women, in 20 hospital and outpatient clinics (May 2019 through January 2021). Results Nonvalvular AF was present in 1038 (91.0%) of women and 935 (94.6%) of men. Compared with men, women were older (mean age 69.2±11.5 years vs. 66.1±14.9 years, p<0.001), and had higher prevalence of hypertension (79.1% vs. 69.5%, p<0.001), diabetes (46.1% vs. 41.7%, p=0.04) and obesity (60.5% vs. 34.6%, p<0.001). Women, however, had lower prevalence of two comorbidities; heart failure (21.5% vs. 28.6, p=0.001) and coronary artery disease (7.7% vs. 15.4%, p<0.001) compared with men. Rate of utilization of oral anticoagulant agents (OACs) was higher in women than men with high and intermediate CHA2DS2 VASc scores (Table). Direct OACs were used in 64.0% of women and 63.3% of men with high risk score (p=NS). Multivariate analysis did not show sex to be an independent predictor of use of OACs. Conclusions Middle Eastern women with AF have worse baseline clinical and risk score profiles compared with men. In disagreement with other regional studies, the majority of these women received guideline-recommended OACs. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Trends in initiation of direct oral anticoagulant therapies for atrial fibrillation in a national population-based cross-sectional study in the French health insurance databases

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e018180 ◽  
Author(s):  
Laetitia Huiart ◽  
Cyril Ferdynus ◽  
Christel Renoux ◽  
Amélie Beaugrand ◽  
Sophie Lafarge ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
National Health ◽  
Oral Anticoagulant ◽  
Vitamin K Antagonists ◽  
Population Based ◽  
Administrative Database ◽  
Direct Oral Anticoagulant ◽  
Health Authorities ◽  
First Choice

ObjectiveUnlike several other national health agencies, French health authorities recommended that the newer direct oral anticoagulant (DOAC) agents only be prescribed as second choice for the treatment of newly diagnosed non-valvular atrial fibrillation (NVAF), with vitamin K antagonists (VKA) remaining the first choice. We investigated the patterns of use of DOACs versus VKA in the treatment of NVAF in France over the first 5 years of DOAC availability. We also identified the changes in patient characteristics of those who initiated DOAC treatment over this time period.MethodsBased on the French National Health Administrative Database, we constituted a population-based cohort of all patients who were newly treated for NVAF between January 2011 and December 2015. Trends in drug use were described as the percentage of patients initiating each drug at the time of treatment initiation. A multivariate analysis using logistic regression model was performed to identify independent sociodemographic and clinical predictors of initial anticoagulant choice.ResultsThe cohort comprised 814 446 patients who had received a new anticoagulant treatment for NVAF. The proportion of patients using DOACs as initial anticoagulant therapy reached 54% 3 months after the Health Ministry approved the reimbursement of dabigatran for NVAF, and 61% by the end of 2015, versus VKA use. In the multivariate analysis, we found that DOAC initiators were younger and healthier overall than VKA initiators, and this tendency was reinforced over the 2011–2014 period. DOACs were more frequently prescribed by cardiologists in 2012 and after (adjusted OR in 2012: 2.47; 95% CI 2.40 to 2.54).ConclusionDespite recommendations from health authorities, DOACs have been rapidly and massively adopted as initial therapy for NVAF in France. Observational studies should account for the fact that patients selected to initiate DOAC treatment are healthier overall, as failure to do so may bias the risk–benefit assessment of DOACs.

scholarly journals Choice of New Oral Anticoagulant Agents Versus Vitamin K Antagonists in Atrial Fibrillation

2015 ◽  
Vol 21 (2) ◽  
pp. 150-156 ◽  
Author(s):  
José Moreno-Arribas ◽  
Vicente Bertomeu-González ◽  
Manuel Anguita-Sanchez ◽  
Ángel Cequier ◽  
Javier Muñiz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Oral Anticoagulant ◽  
Vitamin K Antagonists ◽  
Anticoagulant Agents ◽  
New Oral Anticoagulant

scholarly journals HAS-BLED scor system for the assessment of risk of breathing of patients on oral anticoagulant therapy // HAS-BLED skor sistem bodovanja za procjenu rizika od krvarenja pacijenata na oralnoj antikoagulantnoj terapiji

2018 ◽  
Vol 5 (1) ◽  
pp. 11
Author(s):  
Daniela Dobrovoljski
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Heart Rhythm ◽  
Clinical Problem ◽  
Coagulation Factors ◽  
Heart Rhythm Disorders ◽  
Anticoagulant Drugs

Oral anticoagulant drugs (OALs) are effective agents in the prevention and treatment of thromboembolic complications. However, despite standardization and application progression, OALs represent a significant clinical problem because they are small-therapeutic medicines that easily interact with food and medicine, which can substantially affect the increased or weakened therapeutic effect. Oral anticoagulants are 4-hydroxycoumarin derivatives and vitamin K antagonists, and their pharmacological activity is based on inhibition of the synthesis of coagulation factors in the liver. These drugs are effective in the prevention of venous thromboembolism, acute myocardial infarction (AIM), heart rhythm disorders by type of atrial fibrillation, stroke prevention, and the like. The most important and clinically commonly undesirable effect of OAL is bleeding. The risk of bleeding is greatest during the introduction of the drug in therapy and for the first few months of the onset of therapy. HAS-BLED scor is a skoring system developed to estimate the 1-year risk of major bleeding in patients with atrial fibrillation and is also used for other indications.

The Combination of Oral Anticoagulant and Antiplatelet Therapies: Stay One Step Ahead

2020 ◽  
Vol 25 (5) ◽  
pp. 391-398
Author(s):  
Fabiana Lucà ◽  
Simona Giubilato ◽  
Stefania Angela Di Fusco ◽  
Angelo Leone ◽  
Stefano Poli ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Venous Thromboembolism ◽  
Antiplatelet Therapy ◽  
Oral Anticoagulant ◽  
Acute Coronary Syndromes ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Clinical Scenarios ◽  
Coronary Syndromes

Antithrombotic drugs, which include antiplatelets and anticoagulants, are effective in prevention and treatment of many cardiovascular disorders such as acute coronary syndromes, stroke, and venous thromboembolism and are among the drugs most commonly prescribed worldwide. The advent of direct oral anticoagulants, which are safer alternatives to vitamin K antagonists and do not require laboratory monitoring, has revolutionized the treatment of nonvalvular atrial fibrillation and venous thromboembolism. The combination of oral anticoagulant and antiplatelet therapy is required in many conditions of great clinical impact such as the coexistence of atrial fibrillation and coronary artery disease, with indication to percutaneous coronary intervention. However, strategies that combine anticoagulant and antiplatelet therapies lead to a significant increase in bleeding rates and it is crucial to find the right combination in the single patient in order to optimize the ischemic and bleeding risk. The aim of this review is to explore the evidence and controversies regarding the optimal combination of anticoagulant and antiplatelet therapy through the consideration of past dogmas and new perspectives from recent clinical trials and to propose a tailored therapeutic approach, according to specific clinical scenarios and individual patient characteristics. In particular, we separately explored the clinical settings of stable and acute coronary syndromes and percutaneous revascularization in patients with atrial fibrillation.

Chronic kidney disease and anticoagulation: from vitamin K antagonists and heparins to direct oral anticoagulant agents

2017 ◽  
Vol 12 (8) ◽  
pp. 1101-1108 ◽  
Author(s):  
Savino Sciascia ◽  
Massimo Radin ◽  
Karen Schreiber ◽  
Roberta Fenoglio ◽  
Simone Baldovino ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vitamin K ◽  
Oral Anticoagulant ◽  
Vitamin K Antagonists ◽  
Direct Oral Anticoagulant ◽  
Anticoagulant Agents

Which Patients Would Be Willing to Change Anticoagulation From Vitamin-K Antagonists to a New Oral Anticoagulant?

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4318-4318
Author(s):  
Job Harenberg ◽  
Svetlana Marx ◽  
Nadja Abou-Ayash ◽  
Christophe Kremer ◽  
Vera Hoeing ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Vitamin K ◽  
Logistic Regression Analysis ◽  
Oral Anticoagulant ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulant ◽  
Willingness To Change

Abstract Abstract 4318 New oral anticoagulants have generated promising data on the prophylaxis of systemic and non-systemic embolism in patients with atrial fibrillation and treatment of acute venous thromboembolism and prolonged prophylaxis of recurrent events. For patients on chronic treatment with vitamin-K antagonists (VKA) we analysed the motivation and willingness to change the anticoagulation from VKA to new oral anticoagulants. Patients (n=110) on stable treatment with VKA for at least 3 months (indication for anticoagulation: atrial fibrillation or VTE) completed a validated personality inventory (Freiburger Persönlichkeitsinventar FPI-R), and a self-developed questionnaire on general attitudes regarding anticoagulant therapy (Q1). Patients were divided in two groups according to the reply to the question weather they were willing to switch to a new oral anticoagulant. Out of these sets of questions 7 questions were identified by means of a logistic regression analysis for the willingness to change anticoagulation with VKA to a new oral anticoagulant. The same patients completed this shortened questionnaire (Q2) (n=85) thereafter. Logistic regression analysis defined the 7 items of the FPI and Q1 questionaires as relevant for willingness of patients to change the medication. The probability to change medication was 98% using the 7 questions (Q2) compared to the 2 comlete questionnaires. The items were: extraversion – introversion scale on the FPI-R consisting of 14 questions, and from Q1: hope for a better quality of life with a new anticoagulant, no scepticism for new drugs, wish of a lack of routine monitoring for dose adjustment, relevance of the practitioners opinion, thoughts in the past of alternatives for anticoagulation, and difficulty to adjust the prothrombin time. Using Q2 85% of patients confirmed to be willing to change the anticoagulant drug compared to Q1 (chi square test p<0.0001). Seven questions were identified and confirmed to identify patients for their willingness to change anticoagulation from VKA to a new oral anticoagulant. Disclosures: No relevant conflicts of interest to declare.

Abstract 154: Adherence to Rivaroxaban Compared to Other Oral Anticoagulant Agents Among Patients With Non-Valvular Atrial Fibrillation

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Colleen A McHorney ◽  
Veronica Ashton ◽  
François Laliberté ◽  
Guillaume Germain ◽  
Willy Wynant ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Patient Outcomes ◽  
Real World ◽  
Oral Anticoagulant ◽  
Index Date ◽  
Absolute Difference ◽  
Real World Data ◽  
Anticoagulant Agents ◽  
Proportion Of Days Covered ◽  
Adherence To Therapy

Background: Adherence to oral anticoagulant (OAC) agents is important for patients with non-valvular atrial fibrillation (NVAF) to prevent potentially severe adverse events. Objectives: To compare real-world adherence rates for rivaroxaban vs other oral anticoagulant agents (apixaban, dabigatran, and warfarin) among patients with NVAF using claims-based data. Methods: Healthcare claims from the IMS Health Real-World Data Adjudicated Claims database (01/2011-06/2015) were used to assess 6 month adherence rates defined as the percentage of patients with proportion of days covered (PDC) ≥0.8 and ≥0.9. Patients were included if they had ≥2 dispensings of rivaroxaban, apixaban, dabigatran, or warfarin at least 180 days apart (the first was termed as the index date), had > 60 days of supply, had ≥ 6 months of pre-index eligibility, had ≥ 1 AF diagnosis pre-index or at index date, and without valvular involvement. A logistic regression model was used to evaluate adherence to therapy adjusting for sociodemographic and clinical characteristics, insurance type, index month and year, previous OAC use, and mental-health risk factors for non-adherence (e.g., mental disorders, bipolar). Results: A total of 13,645 rivaroxaban, 6,304 apixaban, 3,360 dabigatran, and 13,366 warfarin patients were identified. A significantly higher proportion of rivaroxaban users were adherent to therapy (PDC ≥ 0.8 at 6 months vs apixaban, dabigatran, and warfarin users; Table). After adjustment, the proportion of patients adherent to therapy remained significantly higher for rivaroxaban users vs apixaban (absolute difference [AD]: 5.8%), dabigatran (AD: 9.5%), and warfarin users (AD: 13.6%; all P<0.001; Table). More pronounced differences were found with a PDC ≥0.9 (Table). Conclusion: Among NVAF patients, rivaroxaban was associated with significantly higher adherence rates relative to other OACs, whether using a PDC of ≥0.8 or ≥0.9, which could translate into improved patient outcomes and lower healthcare costs.

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