THE USE OF PACEMAKER DIAGNOSTICS FOR SUPPORTING THE ANTICOAGULATION TREATMENT MANAGEMENT

In this work, the analysis of data on atrial fibrillation (AF) burden from dual chamber pacemakers is used for supporting the anticoagulation treatment management. The aim is to evaluate the benefit of basic diagnostic functions to support oral anticoagulation therapy in patients with atrial fibrillation. These patients have increased risk of thromboembolism. If patients have an implanted pacemaker, the device’s diagnostic features monitor the frequency and duration of atrial fibrillation episodes. This data can then be used for further decisions. Statistical data processing was performed on a group of 117 patients with an implanted dual chamber pacemaker. From these results, we evaluated the benefits of the algorithms. In the whole group, a trend was observed in increase of the AF burden between the two monitored periods. The increase of AF burden occurred in 17 patients, while the decrease occurred in 6 patients only. Using simple logic functions, the numbers of patients with different binary values of the presence of AF, the presence of oral anticoagulation therapy, the risk CHA2DS2-VASc score and the values of AF burden were determined. Thus, in the whole group of patients, the diagnostic functions of the implanted devices contributed to the change in oral anticoagulation therapy for 24% of patients.

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Outpatient Management of Oral Anticoagulation Therapy in Patients with Nonvalvular Atrial Fibrillation

Bosnian Journal of Basic Medical Sciences ◽

10.17305/bjbms.2009.2787 ◽

2009 ◽

Vol 9 (4) ◽

pp. 313-319 ◽

Cited By ~ 2

Author(s):

Aida Kulo ◽

Nedžad Mulabegović ◽

Jasna Kusturica ◽

Hasija Hadžić ◽

Lejla Burnazović-Ristić ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulation ◽

Anticoagulation Therapy ◽

Dose Titration ◽

Nonvalvular Atrial Fibrillation ◽

Annual Dose ◽

Oral Anticoagulation Therapy ◽

Anticoagulation Treatment ◽

One Year

Due to heightened risk for thromboembolic complications, nonvalvular atrial fibrillation (NVAF) presents an absolute indication for long-term oral anticoagulation therapy. This was an observational, analytical, randomised, one-year clinical study, conducted in the Blood Transfusion Institute Sarajevo, Bosnia & Herzegovina. The aim of this study was to present the oral anticoagulation treatment in terms of International normalised ratio (INR) monitoring and warfarin/acenocoumarol dose titration in 117 patients with NVAF. INR values, the doses of warfarin and acenocoumarol, as well as the tendency and adequacy of their changes were monitored. Percentages of the therapeutic INR values were 51,77% and 53,62%, subtherapeutic 42,84% and 35,86%, and supratherapeutic 5,39% and 10,53% for the warfarin and acenocoumarol treatment, respectively. The average total weekly doses (TWD) which most frequently achieved the therapeutic INR values were 27,89±12,34 mg and 20,44±9,94 mg, for warfarin and aceno- coumarol, respectively. The dose changes with the INR values 1,7 or lower/3,3 or higher were omitted in 13,46% and 15,63%, and with the INR values 1,8-3,2 were noted in 8,62% and 13,48% of all the check-up visits in the warfarin and acenocoumarol group, respectively. The annual dose changes were noted in 24,65% and 31,41%, and the daily dose changes in 74,43% and 73,36% of all the check-up visits of warfarin and acenocoumarol group, respectively. We can conclude that the management of the oral anticoagulation treatment in our country is in accordance with the relevant recommendations, but with the present tendency toward underdosing and unnecessary frequent dose changing.

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Depression and Uptake of Oral Anticoagulation Therapy in Patients With Atrial Fibrillation

Medical Care ◽

10.1097/mlr.0000000000001268 ◽

2020 ◽

Vol 58 (3) ◽

pp. 216-224 ◽

Cited By ~ 1

Author(s):

Morten Fenger-Grøn ◽

Claus H. Vestergaard ◽

Lars Frost ◽

Dimitry S. Davydow ◽

Erik T. Parner ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulation ◽

Anticoagulation Therapy ◽

Oral Anticoagulation Therapy

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Consideration of non-valvular atrial fibrillation with left atrial appendage thrombus formation despite under appropriate oral anticoagulation therapy

European Heart Journal ◽

10.1093/ehjci/ehaa946.0071 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H Shiraki ◽

H Tanaka ◽

K Yamashita ◽

Y Tanaka ◽

K Sumimoto ◽

...

Keyword(s):

Atrial Fibrillation ◽

Logistic Regression ◽

Regression Analysis ◽

Oral Anticoagulation ◽

Left Atrial ◽

Thrombus Formation ◽

Anticoagulation Therapy ◽

Left Ventricular ◽

Volume Index ◽

Oral Anticoagulation Therapy

Abstract Background Atrial fibrillation (AF) is the most frequently sustained cardiac arrhythmia, with a prevalence of about 2–3% in the general population. In accordance with CHADS2 or CHA2DS2-VASc score, appropriate oral anticoagulation therapy such as warfarin or direct oral anticoagulants (DOAC) significantly reduced the risk of thromboembolic events. However, left atrial (LA) thrombus can be detected in the LA appendage (LAA) in AF patients despite appropriate oral anticoagulation therapy. Purpose Our purpose was to investigate the associated factors of LAA thrombus formation in non-valvular atrial fibrillation (NVAF) patients despite under appropriate oral anticoagulation therapy. Methods We retrospectively studied consecutive 286 NVAF patients for scheduled catheter ablation or electrical cardioversion for AF in our institution between February 2017 and September 2019. Mean age was 67.1±9.4 years, 79 patients (29.5%) were female, and 140 (52.2%) were paroxysmal AF. All patients underwent transthoracic and transesophageal echocardiography before catheter ablation or electrical cardioversion. All patients received appropriate oral anticoagulation therapy including warfarin or DOAC for at least 3 weeks prior to transesophageal echocardiography based on the current guidelines. LAA thrombus was defined as an echodense intracavitary mass distinct from the underlying endocardium and not caused by pectinate muscles by at least three senior echocardiologists. Results Of 286 NVAF patients with under appropriate oral anticoagulation therapy, LAA thrombus was observed in 9 patients (3.3%). Univariate logistic regression analysis showed that age, paroxysmal AF, CHADS2 score ≥3, left ventricular end-diastolic volume index (LVEDVI), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), LA volume index (LAVI), mitral inflow E and mitral e' annular velocities ratio (E/e'), and LAA flow were associated with LAA thrombus formation. It was noteworthy that multivariate logistic regression analysis showed that LAA flow was independent predictor of LAA thrombus (OR: 0.72, 95% CI: 0.59–0.89, p<0.005) as well as LVEF. Furthermore, receiver operating characteristic (ROC) curve analysis identified the optimal cutoff value of LAA flow for predicting LAA thrombus as ≤15cm/s, with a sensitivity of 88%, specificity of 93%, and area under the curve (AUC) of 0.95. Conclusions LAA flow was strongly associated with LAA thrombus formation even in NVAF patients with appropriate oral anticoagulation therapy. According to our findings, further strengthen of oral anticoagulation therapy or percutaneous transcatheter closure of the LAA may be considered in NVAF patients with appropriate oral anticoagulation therapy but low LAA flow, especially <15cm/s. Funding Acknowledgement Type of funding source: None

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