Analysis of antithrombotic therapy in elderly patients with nonvalvular atrial fibrillation in the Kyrgyz Republic and ways to increase treatment adherencе

Aim. To analyze anticoagulant therapy in elderly patients with non-valvular atrial fibrillation and ways to increase adherence in the work of a specialized team. Methods. The study followed 250 patients with non-valvular atrial fibrillation aged 65 to 74 years (mean age 70.74.39 years). The patients were divided into three groups: the first group included 105 people, who were prescribed warfarin in a retrospective study; the second group 57 people treated with rivaroxaban, and the third group 88 people treated with warfarin. The second and third groups were prospective study groups which were supervised by a specialized team of physicians. The groups were matched on sex and age, comorbidities. Statistical data analysis and mathematical processing were performed by using the methods of descriptive and variational statistics. Most parameters reported as absolute values and percentages, while quantitative data the 25th and 75th percentiles. Results. All patients included in the study had a high risk of developing thromboembolic complications by their CHA2DS2-VASc score (2) and a low risk of developing hemorrhagic complications on the HAS-BLED scale (average score 1.490.04). They were prescribed anticoagulant therapy. By the end of the year follow-up from the start of anticoagulant therapy, only 9.5% of patients were treatment adherent, in the second group 43.8%, in the third group 70.5% of patients. The reason for refusing to take warfarin in the vast majority of cases was the inability to control the international normalized ratio, medical contraindications, and the high cost of the drug in prescribing rivaroxaban. The results showed that the majority of patients with atrial fibrillation (90.5%) receive inadequate antithrombotic therapy in routine outpatient clinical practice. At the same time, in a very small number of patients (9.5%) receiving warfarin, this type of therapy can be considered adequate (60% or more of the stay time in the therapeutic range of international normalized ratio of 2.0 to 3.0). Conclusion. Anticoagulant therapy prescription under the supervision of a specialized team contributes to a significant improvement in treatment adherence (from 43.8 to 70.5%); promising in the future is the use of drugs from the group of new oral anticoagulants that do not require routine monitoring of coagulogram.

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Changes in Prescribing Antithrombotic Therapy in Patients with Atrial Fibrillation in the Multidisciplinary Hospital in Volgograd from 2012 to 2020

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2021-12-06 ◽

2022 ◽

Vol 17 (6) ◽

pp. 831-836

Author(s):

A. S. Gerasimenko ◽

O. V. Shatalova ◽

V. S. Gorbatenko ◽

V. I. Petrov

Keyword(s):

Atrial Fibrillation ◽

Clinical Practice ◽

Clinical Guidelines ◽

Antithrombotic Therapy ◽

Heart Valves ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

International Normalized Ratio ◽

Prosthetic Heart Valves ◽

Discharge From Hospital

Aim. To study the frequency of prescribing antithrombotic agents in patients with non-valvular atrial fibrillation (AF) in real clinical practice, to evaluate changes of prescriptions from 2012 till 2020.Material and methods. The medical records of inpatients (Form 003/y) with the diagnosis AF, hospitalized in the cardiological department were analyzed. According to the inclusion criteria, the patients were over 18 years of age, established diagnosis of non-valvular AF. There were two exclusion criteria: congenital and acquired valvular heart disease and prosthetic heart valves. In retrospective analysis we have included 263 case histories in 2012, 502 ones in 2016 and 524 in 2020. CHA2DS2-VASc score was used for individual stroke risk assessment in AF. The rational use of the antithrombotic therapy was evaluated according with current clinical practice guidelines at analyzing moment.Results. During period of observation the frequency of antiplatelet therapy significantly decreased from 25,5% to 5,5% (р<0.001), decreased the frequency of administration of warfarin from 71,9% to 18,3% (р<0.001). The frequency of use of direct oral anticoagulants increased in 2020 compared to 2016 (р<0.001). For patients with a high risk of stroke anticoagulant therapy was administered in 71.8% of cases in 2012, 88.5% in 2016 and 92.5% in 2020. Before discharge from hospital majority of patients (72%) achieved a desired minimum international normalized ratio (INR) from 2.0 to 3.0 in 2012. In 2016 and 2020 an only 33% and 40.6% of patients achieved INR (2.0-3.0).Conclusion. Doctors have become more committed to following clinical guidelines during the period of the investigation. In 2020 antithrombotic therapy for atrial fibrillation was suitable according to current clinical guidelines.

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Comparative Analysis of Antithrombotic Therapy in In-Patients with Atrial Fibrillation

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2019-15-1-49-53 ◽

2019 ◽

Vol 15 (1) ◽

pp. 49-53

Author(s):

V. I. Petrov ◽

O. V. Shatalova ◽

A. S. Gerasimenko ◽

V. S. Gorbatenko

Keyword(s):

Atrial Fibrillation ◽

High Risk ◽

Anticoagulant Therapy ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Thromboembolic Complications ◽

Antithrombotic Agents ◽

Cardiology Department ◽

Number Of Patients

Aim. To study the frequency of prescribing antithrombotic agents in patients with non-valvular atrial fibrillation (AF) who were hospitalized in the cardiology department of a multidisciplinary hospital.Material and methods. A retrospective one-time study of medical records of 765 patients with non-valvular AF treated in the cardiology department of a multidisciplinary hospital in 2012 and 2016 was performed.Results. All patients were stratified in three groups depending on the CHA2DS2-VASc score. The frequency of prescribing antithrombotic agents was evaluated in each group. A low risk of thromboembolic complications was found in 1% (n=3) of patients in 2012 and 0.6% (n=3) in 2016. All these patients received antithrombotic agents. CHA2DS2-VASc=1 was found in 6% (n=15) of patients with AF in 2012 and in 3.4% (n=17) in 2016. A significant number of patients in this group received anticoagulant therapy with vitamin K antagonists (warfarin) or with direct oral anticoagulants. A high risk of thromboembolic complications (CHA2DS2-VASc≥2) was found in 93% of patient (n=245) in 2012 and in 96% (n=482) in 2016. Anticoagulant therapy was prescribed in 70.2% (n=172) patients with high risk in 2012 and 80% (n=387) in 2016. However, some patients with high risk of thromboembolic complications did not have the necessary therapy.Conclusion. Positive changes in the structure and frequency of prescribing anticoagulant drugs in patients with AF and a high risk of thromboembolic complications were found during the years studied.

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Adherence to Anti-coagulant therapy in elderly patients with Atrial fibrillation in the Kyrgyzstan

Biomedicine ◽

10.51248/.v41i3.1207 ◽

2021 ◽

Vol 41 (3) ◽

pp. 682-685

Author(s):

Kanat kyzy Bazira ◽

Nazgul Kinderbaeva ◽

Gulnora Karataeva ◽

Sabira Mamatova ◽

Ulan Kundashev ◽

...

Keyword(s):

Atrial Fibrillation ◽

Elderly Patients ◽

Warfarin Therapy ◽

Anticoagulation Therapy ◽

International Normalized Ratio ◽

Adverse Outcomes ◽

Drug Of Choice ◽

Number Of Patients ◽

Elderly Outpatients

Introduction: Anticoagulant therapy can prevent adverse outcomes of Atrial fibrillation (AF), reducing the risk of stroke by 64% and death by 25%. The present study aimed to assess treatment adherence in elderly patients with non-valvular atrial fibrillation (NVAF) who were prescribed the vitamin K antagonist warfarin. Materials and methods: In the present retrospective study, we analyzed the medical records of 202 elderly outpatients with NVAF aged between 65 and 74 years (mean ± SD: 68.7 ± 10.2 years). Results: Problems associated with warfarin arose throughout the follow-up period. After 1 month of treatment, the number of patients taking warfarin had decreased to 71.3% of all patients; less than half of the patients (46%) were still taking the drug. In subsequent periods, the number continued to decrease; of all patients who had been prescribed warfarin with periodic international normalized ratio (INR) control, only 19 (9.4%) remained after 1 year. Our study revealed inadequate anticoagulation therapy in elderly patients, probably because most patients refused warfarin therapy because they could not control their INR. Moreover, significantly more rural residents than urban residents refused therapy (48 vs. 22; p < 0.05). Doctors underprescribed anticoagulants because they feared hemorrhagic complications in their patients. Conclusion: The results of the present study showed that anticoagulants were underprescribed at the outpatient stage in centers of family medicine in our country. The main drug of choice for specialists remains warfarin, which only provides adequate therapy in a small number of patients (9.4%).

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Anticoagulation therapy in the elderly with non-valvular atrial fibrillation: a double-edged sword

Geriatric Care ◽

10.4081/gc.2017.6371 ◽

2017 ◽

Vol 3 (2) ◽

Cited By ~ 3

Author(s):

Francesco Vetta ◽

Gabriella Locorotondo ◽

Giampaolo Vetta

Keyword(s):

Atrial Fibrillation ◽

Elderly Patients ◽

Anticoagulant Therapy ◽

Vitamin K ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Anticoagulation Therapy ◽

Treatment Strategies ◽

The Elderly ◽

Hemorrhagic Events

Prevalence of non-valvular atrial fibrillation is increasing over time. Particularly in elderly population, treatment strategies to reduce the rate of stroke are challenging and still represent an unsolved cultural question. Indeed, the risk of thromboembolism increases in the elderly in parallel with the risk of bleeding. The frequent coexistence of several morbidities, frailty syndrome, polypharmacy, chronic kidney disease and dementia strengthens the perception that risk-benefit ratio of anticoagulant therapy could be unfavorable, and explains why such treatment is underused in the elderly. Recently, the introduction of non-vitamin K oral anticoagulants (NOACs) has allowed us to overcome the large number of limitations imposed by the use of vitamin K antagonists. In this manuscript, the benefits of individual NOACs in comparison with warfarin in elderly patients are reviewed. Targeted studies on complex elderly patients are needed to test usefulness of a geriatric comprehensive assessment, besides the scores addressing risk of thromboembolic and hemorrhagic events. In the meantime, it is mandatory that use of anticoagulant therapy in most elderly people, currently excluded from randomized controlled trials, is prudent and responsible.

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Antithrombotic Therapy in Elderly Patients with Atrial Fibrillation: The State of the Problem in the Real Clinical Practice of a Family Medicine Doctor

Acta biomedica scientifica ◽

10.29413/abs.2021-6.2.7 ◽

2021 ◽

Vol 6 (2) ◽

pp. 63-69

Author(s):

Bazira Kanat кyzy ◽

N. K. Kinderbaeva ◽

S. O. Turdaliyev ◽

Zh. A. Mahmudova ◽

U. K. Kundashev ◽

...

Keyword(s):

Atrial Fibrillation ◽

Clinical Practice ◽

Family Medicine ◽

Anticoagulant Therapy ◽

Antithrombotic Therapy ◽

Age Groups ◽

Target Range ◽

Specialized Team ◽

Real Clinical Practice

Introduction. The research aimed at studying the efficacy and safety of anticoagulant therapy in patients with atrial fibrillation (AF), especially in older age groups, is now increasingly relevant.The aim of the study is to analyze the situation with prescribing anticoagulant therapy in elderly and senile persons with atrial fibrillation in real clinical practice and to demonstrate the possibility of improving the quality of observation and management of a group of patients as part of the work of a specialized team.Materials and methods. A total of 2,770 medical records of outpatient patients with atrial fibrillation were studied for the period from 2017 to 2019. Of this number, 320 patients with AF of nonvalvular etiology were selected, the average age of which was 70.3 ± 8.15 years. There were 270 women and 50 men. An observational prospective study in 45 elderly and senile patients with AF of non-valvular etiology was carried out by a team of specialized doctors for 12 months.Results. Of the 301 patients, anticoagulant therapy was prescribed to 166 (55.1 %), of which only 17 (10.2 %) people received proper anticoagulant therapy. The excessive activity was observed in 114 (37.9 %) patients, who underwent antiplatelet therapy with aspirin, and 21 (7.0 %) patients remained without any treatment with anticoagulants nor antiplatelet agents. Although, in the case of both, prescribing aspirin and not prescribing, anticoagulants have been indicated. In the prospective part of the study (for 12 months), all 45 patients continued to take anticoagulants and were systematically monitored. The INR in the target range over 60 % of the time was achieved in 37 % of patients receiving warfarin therapy.Conclusion. In the actual clinical practice of Kyrgyzstan family medicine centers, older patients with atrial fibrillation receive inadequate antithrombotic therapy. The main drug of choice for specialists remains warfarin, a therapy that can be recognized as adequate only in a small number (16 %) of patients. The ability to improve the quality of surveillance and management of a group of patients with AF and high adherence to treatment was demonstrated by the work of a specialized team of doctors.

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Laboratory bleeding predictors in elderly patients with atrial fibrillation taking direct oral anticoagulants

Medical Council ◽

10.21518/2079-701x-2019-21-40-43 ◽

2020 ◽

pp. 40-43

Author(s):

M. A. Gabitova ◽

P. M. Krupenin ◽

A. A. Sokolova ◽

D. A. Napalkov ◽

V. V. Fomin

Keyword(s):

Atrial Fibrillation ◽

Elderly Patients ◽

Anticoagulant Therapy ◽

Patient Monitoring ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Laboratory Methods ◽

Increased Risk ◽

Hemorrhagic Events ◽

Clinically Significant

Atrial fibrillation (AF) is one of the most common arrhythmias in patients ≥75 years of age. The increased risk of thrombosis due to age and the large number of concomitant diseases makes it evident that anticoagulant therapy is necessary. However, the same factors increase the risk of hemorrhagic complications, which are among the most dangerous side effects of anticoagulant therapy. That is why it is very important to identify patients with the highest probability of bleeding, whether large or small clinically significant and minor. The purpose of our study was to study the prognostic value of laboratory methods of examination with regard to the development of hemorrhagic events in elderly patients with AF taking direct oral anticoagulants (DOAC). The study enrolled 102 patients ≥75 years of age with AF of non-valve etiology taking dabigatran, apixaban, rivaroxaban at full or reduced doses. Anticoagulants were administered by outpatient and inpatient physicians. Both previous experience with DOAC prior to inclusion in the trial (if DOAC was previously prescribed) and prospective patient monitoring after inclusion in the trial were analyzed. The minimum analyzed period of DOAC intake was 18 months. Patients who underwent (n = 19) and did not undergo (n = 83) hemorrhagic events (all events were considered small by ISTH criteria) did not differ in any of the laboratory indicators potentially considered as predictors of hemorrhagic events.

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Aspects of anticoagulant therapy in patients with atrial fibrillation in the light of updated guidelines of the European society of cardiology 2020: the position of dabigatran

Atherothrombosis Journal ◽

10.21518/2307-1109-2020-2-17-26 ◽

2020 ◽

pp. 17-26

Author(s):

E. S. Kropacheva ◽

E. P. Panchenko

Keyword(s):

Atrial Fibrillation ◽

Anticoagulant Therapy ◽

European Society ◽

Treatment Strategy ◽

Antithrombotic Therapy ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Integrated Approach ◽

Risk Of Bleeding ◽

European Society Of Cardiology

This review focuses on some aspects of anticoagulant therapy in the updated clinical guidelines for atrial fibrillation of the European society of cardiology, published in 2020. Atrial fibrillation is a polymorbid continuously developing syndrome, and therefore the treatment strategy is based on a comprehensive assessment of the patient, including the risk of stroke, the presence and severity of symptoms, and an assessment of structural heart disease and comorbidities. The review describes the principles of the proposed integrated approach, abbreviated “ABC pathway”, as reflecting the three main directions of the treatment strategy. According to experts, the clinical picture of AF (i.e. first detected, paroxysmal, persistent, long-term persistent or permanent) should not determine the indications for the appointment of anticoagulant therapy. The CHA2DS2-VASc scale continues to be the basis for stratification of thromboembolic risk. The role of dabigatran in primary and secondary prevention of stroke and systemic embolism in patients with atrial fibrillation is described. Changes in the position of experts regarding the assessment of bleeding risk are highlighted in order to help identify unmodified and eliminate modifiable risk factors for bleeding, as well as to identify AF patients who are potentially at high risk of bleeding for more frequent monitoring and monitoring of their condition. Questions about the use of direct oral anticoagulants in the choice of rhythm control tactics are highlighted separately. The use of dabigatran in patients undergoing cardioversion and catheter ablation is justified. Practical questions about the continuous strategy of anticoagulant therapy during ablation are highlighted separately. Changes related to multicomponent therapy after percutaneous coronary intervention are highlighted. The main measure to improve the safety of combined antithrombotic therapy is to minimize the duration of triple therapy. The updated recommendations supportlimiting the duration of triple antithrombotic therapy to 1 month, and also provide for early discontinuation of aspirin (≤1 week) and continuation of double antithrombotic therapy in cases of uncomplicated stenting and low risk of thrombosis, or when the risk of bleeding exceeds the risk of thrombotic events.

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Assessment of Antithrombotic Therapy in Patients with Atrial Fibrillation for 2015-2017 According to the Registry of the Clinic of the Scientific Research Institute of Medical Problems of the North of Krasnoyarsk City

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2019-15-1-43-48 ◽

2019 ◽

Vol 15 (1) ◽

pp. 43-48

Author(s):

A. A. Tuchkov ◽

N. G. Gogolashvili ◽

R. A. Yaskevich

Keyword(s):

Atrial Fibrillation ◽

High Risk ◽

Antithrombotic Therapy ◽

Heart Valves ◽

Oral Anticoagulants ◽

International Normalized Ratio ◽

Thromboembolic Complications ◽

Medical Problems ◽

The North ◽

Cardiology Department

Aim. To evaluate the volume of antithrombotic therapy (ATT) at the prehospital stage in connection with the risk of thromboembolic complications, and also to study the dynamics of the frequency of administration of oral anticoagulants (ОAC) in patients with atrial fibrillation (AF) in 2015-2017.Material and methods. The registry included 562 patients with AF at the age of 18 years and older, hospitalized in the cardiology department during 2015-2017. The registry did not include patients with AF and mechanical heart valves, mitral stenosis. The diagnosis of AF was established in accordance with the current recommendations. All patients had an assessment of the risk of thromboembolic complications on the CHA2DS2-VASc scale, the risk of bleeding on the HAS-BLED scale. The incidence of ATT at the prehospital stage was assessed depending on the risk of thromboembolic complications based on patient questioning and analysis of medical records. In addition, an assessment of the dynamics of the frequency of the OAC prescription during 2015-2017 was conducted.Results. The overwhelming majority of patients with AF (96.1%) belonged to the group of high-risk of cardioembolic strokes according to the CHA2DS2-VASc scale and had indications for OAC therapy. The frequency of OAC prescription in patients with AF who were admitted to the cardiology department was 32% at the prehospital stage, of which 19.8% of patients took warfarin and 12.2% – direct OAC. The target level of the international normalized ratio (from 2.0 to 3.0) at the time of hospitalization was observed only in 33.6% of patients taking warfarin. Over the observation period, there was a tendency to increase the frequency of OAC prescription from 30% in 2015 to 38.4% in 2017.Conclusion. Only 32% of patients with AF and high risk of thromboembolic complications received adequate antithrombotic therapy at the prehospital stage. According to the registry the frequency of OAC prescription in patients with AF during 2015-2017 increased by 8.4%. At the same time, there was a significant increase in the frequency of direct OAC prescription.

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Elderly Patients with Atrial Fibrillation: Focus on Comorbidity and Safety of Anticoagulant Therapy

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2019-15-4-553-557 ◽

2019 ◽

Vol 15 (4) ◽

pp. 553-557 ◽

Cited By ~ 1

Author(s):

D. A. Napalkov ◽

A. A. Sokolova

Keyword(s):

Atrial Fibrillation ◽

Elderly Patients ◽

Anticoagulant Therapy ◽

Safety Profile ◽

Randomized Clinical Trials ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Systemic Embolism ◽

Good Adherence ◽

Younger Patients

The article discusses issues related to the prescription of anticoagulant therapy to elderly patients with atrial fibrillation (AF), especially those over 70 and 80 years of age. The relevance of the issue is primarily due to the prevalence of AF in this cohort of patients, and the second is due to the higher incidence of comorbidity. The presented material demonstrates the peculiarities of anticoagulant therapy application in groups of patients older than 75, based on the data of randomized clinical trials, and also presents extrapolation of the results of RCTs to the real clinical practice (data of registers and cohort trials). The use of unreasonably low doses of oral anticoagulants in elderly patients is debated. It often leads to a decrease in the efficacy of anticoagulant therapy without improving the drugs safety profile. A new validated scale (ABH) for evaluating of anticoagulant therapy safety is presented in the article. The ABH scale can be used before prescribing to patients exactly direct oral anticoagulants. This scale is simpler and more practical than the HAS-BLED scale. The data for the ABH scale are validated based on direct oral anticoagulants in 21,248 patients from the Norwegian register. The presented results demonstrate a favorable efficiency and safety profile of rivaroxaban in comparison with warfarin in patients 75 years and older. Thus, the overall benefit for the use of rivaroxaban against warfarin in patients > 75 years of age in the subanalysis of the ROCKET-AF study was statistically significantly greater than in younger patients with AF. Data on 11121 patients with AF who were treated with rivaroxaban for the prevention of stroke and systemic embolism are included in the combined analysis of the XANTUS, XANAP and XANTUS-EL registers. 96% of patients in the study did not have serious thromboembolic events. The amount of major bleeding was 1.7 per 100 patient-years, and gastrointestinal bleeding was 0.7 per 100 patient-years. This turned out to be less than in some other registry studies. In addition, patients showed good adherence to rivaroxaban treatment: after a year, 77.4% of patients continued to take the drug.

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Pharmacoeconomic aspects of warfarin and new oral anticoagulants use as prevention of thromboembolic complications in patients with atrial fibrillation

Ukrainian Journal of Cardiology ◽

10.31928/1608-635x-2020.4.4553 ◽

2020 ◽

Vol 27 (4) ◽

pp. 45-53

Author(s):

N. V. Bezditko

Keyword(s):

Atrial Fibrillation ◽

Health Care ◽

Anticoagulant Therapy ◽

Direct Action ◽

Oral Anticoagulants ◽

Drug Consumption ◽

Thromboembolic Complications ◽

Total Consumption ◽

Number Of Patients ◽

The Cost

The aim – assessment of pharmacoeconomic feasibility of use for the prevention of thromboembolic complications (cerebral or systemic embolism) in patients with atrial fibrillation indirect anticoagulant warfarin compared with oral anticoagulants direct action in the modern Ukrainian health care system.Materials and methods. Used pharmacoeconomic methods to minimize costs, the mysterious cost of the disease. The supply of medications was determined according to the methodology of PBX/DDD, the economic affordability of medications was determined according to the value of the indicator Ca.s.Results and discussion. Drug consumption was determined according to the ATC/DDD methodology based on the data of the drug market research system Pharmexplorer, the economic availability of drugs was determined according to the value of Ca.s. An analysis of the comparative efficacy and safety of NOAC and warfarin according to the latest systematic reviews and meta-analyzes. According to the results of the analysis of the pharmaceutical market, it is established that currently in active retail sale in Ukraine there are 15 drugs NOAC (2 drugs apixaban, 6 drugs dabigatran and 7 drugs rivaroxaban) and 11 medications warfarin from 4 manufacturers. It is determined which drugs containing the same substance are the cheapest in terms of the cost of one DDD. It is established that the indicator of Ca.s. 80 % of warfarin drugs are moderately available, and all NOAC s are not available. The level of total consumption of anticoagulant drugs in Ukraine in 2019 was 1.7 DDDs, which, taking into account the prevalence of AF, suggests the existence of a significant number of patients with AF who do not receive appropriate anticoagulant therapy. It is established that the level of drug consumption does not depend on the cost of the drug.Conclusions. Under the current conditions of the health care system of Ukraine, warfarin is a more cost-effective drug for the treatment of atrial fibrillation in comparison with NOAC, which should be taken into account when implementing individualized pharmacotherapy of patients. According to the analysis of consumption volumes, it can be assumed that in Ukraine there is a large number of patients with AF who do not receive anticoagulant therapy.

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