Atrial fibrillation in old age: risk management and features of the use of direct oral anticoagulants

Kardiologiia ◽  
2021 ◽  
Vol 61 (6) ◽  
pp. 79-87
Author(s):  
S. G. Kanorskii
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Clinical Situation ◽  
The Russian Federation ◽  
Coronary Events ◽  
Senile Patient ◽  
Reduced Risk ◽  
Real Clinical Practice

Senile patients with atrial fibrillation (AF) are at a higher risk of thromboembolism and hemorrhage than younger patients. Three direct oral anticoagulants (DOAC), apixaban, dabigatran, and rivaroxaban, are registered in the Russian Federation and are extensively used for prevention of stroke in patients with AF. The DOAC treatment of older patients requires considering peculiarities of these patients, clinical situation and properties of individual drugs to achieve the balance of efficiency and safety and a comprehensive protection. According to studies of real clinical practice DOAC may have advantages over warfarin (reduced risk of fractures, diabetes mellitus, and dementia). Compliance with and constancy of the DOAC treatment are important for its efficiency, particularly in senile age. Results of clinical trials and real clinical practice studies have confirmed that rivaroxaban may provide a comprehensive protection for a senile patient with AF due to favorable indexes of efficiency and safety, beneficial effect on the risk of coronary events and impairment оf renal function, whereas once a day dosing of rivaroxaban improves the compliance with this treatment and its constancy.

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

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.

scholarly journals Atrial fibrillation treatment in Russia: work on bugs

2021 ◽  
Vol 28 (3) ◽  
pp. 1-4
Author(s):  
S. G. Kanorskii
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Russian Federation ◽  
Medical Errors ◽  
Clinical Guidelines ◽  
The Future ◽  
The Russian Federation ◽  
Real Clinical Practice

The article discusses the results of a survey of doctors in the Russian Federation with the aim of studying approaches to the treatment of atrial fibrillation in real clinical practice and comparing the results obtained with the current clinical guidelines. Some new data are presented that could change the recommendations in the future; possible causes of medical errors and ways to correct them are discussed.

scholarly journals Clinical efficacy and safety of direct oral anticoagulants in patients with atrial fibrillation in real-world clinical practice

2021 ◽  
Vol 5 (4) ◽  
pp. 196-199
Author(s):  
M.V. Khruslov ◽  
◽  
A.S. Sorokina ◽  
Yu.A. Sapel'nikova ◽  
T.V. Vavilova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Clinical Efficacy ◽  
Real World ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Bleeding Complications ◽  
Efficacy And Safety ◽  
Daily Group ◽  
Thrombotic Complications

Aim: to assess the efficacy and safety of direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AFib) in real-world clinical practice. Patients and Methods: this non-interventional prospective study enrolled 356 patients aged 50-75 years with AFib and creatinine clearance ≥50 ml/min. All patients were divided into three age-matched groups based on DOACs prescribed. Group 1 patients (n=120) received rivaroxaban 20 mg daily. Group 2 patients (n=112) received dabigatran etexilate 150 mg twice daily. Group 3 patients (n=124) received apixaban 5 mg twice daily. The groups were comparable in comorbidities and the risks of thrombotic and hemorrhagic complications. Followup was 2 years after starting treatment. Thrombotic complications, massive bleedings, and death for any reason were considered end-points. Results: no significant differences in the rate of cardiogenic thrombotic complications between the groups were reported. In patients who received apixaban, fewer bleeding complications were diagnosed (insignificant differences). Conclusions: the efficacy and safety of DOACs in patients over 50 years are similar. KEYWORDS: atrial fibrillation, oral anticoagulants, thrombotic complications, infarction, stroke, bleedings. FOR CITATION: Khruslov M.V., Sorokina A.S., Sapel'nikova Yu.A., Vavilova T.V. Clinical efficacy and safety of direct oral anticoagulants in patients with atrial fibrillation in real-world clinical practice. Russian Medical Inquiry. 2021;5(4):196–199 (in Russ.). DOI: 10.32364/2587-6821-2021-5-4-196-199.

scholarly journals Anticoagulant Therapy in “Fragile” Elderly Patients: Current State of the Problem

2019 ◽  
Vol 14 (6) ◽  
pp. 908-916 ◽  
Author(s):  
N. M. Vorobyeva ◽  
O. N. Tkacheva
Keyword(s):  
Clinical Practice ◽  
Elderly Patients ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Evidence Base ◽  
Systemic Embolism ◽  
Randomized Controlled ◽  
Current State ◽  
Practice Trials ◽  
Real Clinical Practice

The review focuses on the use of oral anticoagulants in fragile elderly patients. The issues of prevalence and diagnosis of senile asthenia syndrome or “fragility”, as well as its effects on the risks of thrombosis, bleeding and death, are discussed. The evidence base, which is quite limited, for the participation of fragile elderly patients in randomized controlled trials and real clinical practice trials with direct oral anticoagulants is presented. Nevertheless, one of the studies of real clinical practice showed that only therapy with rivaroxaban (out of three direct oral anticoagulants) compared with warfarin reduced the risk of stroke/systemic embolism and ischemic stroke alone in fragile elderly patients with atrial fibrillation after 2 years of observation.

scholarly journals Effectiveness and Safety of Under or Over-dosing of Direct Oral Anticoagulants in Atrial Fibrillation: A Systematic Review and Meta-analysis of 148909 Patients From 10 Real-World Studies

2021 ◽  
Vol 12 ◽  
Author(s):  
Nan-Nan Shen ◽  
Chi Zhang ◽  
Na Wang ◽  
Jia-Liang Wang ◽  
Zhi-Chun Gu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Confidence Interval ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Cochrane Library ◽  
Asian Patients ◽  
Increased Risk

Background: In routine clinical practice, non-standard doses of direct oral anticoagulants (DOACs) are commonly used in patients with atrial fibrillation (AF). However, data on the clinical outcomes of non-standard doses of DOACs are limited.Methods: The MEDLINE, Embase, and Cochrane Library databases were systematically searched from their inception until 30 June 2020 for studies that reported the effectiveness or safety outcomes of non-standard doses of DOACs compared with on-label doses of DOACs in patients with atrial fibrillation. Non-standard doses of DOACs were defined as under or over-dose of DOACs based on the recommended standard doses in drug labels. A random-effects meta-analysis was performed to calculate the pooled hazard ratio and associated 95% confidence interval (95% confidence interval). Subgroup analyses were conducted according to individual DOACs and different geographic regions.Results: Ten articles involving 148,909 patients with AF were included. There were no significant differences between under-dosing and on-label dosing with respect to stroke/systematic embolism (HR: 1.01, 95% CI: 0.93–1.09), major bleeding (HR: 0.98, 95% CI: 0.77–1.19), intracranial haemorrhage (HR: 1.07, 95% CI: 0.74–1.40), gastrointestinal bleeding (HR: 1.10, 95% CI: 0.82–1.39), and myocardial infarction (HR: 1.07, 95% CI: 0.89–1.25), except for an increased risk of death (HR: 1.37, 95% CI: 1.01–1.73). We observed a significant association between over-dosing of DOACs and increased risk of stroke/systematic embolism (HR: 1.18, 95% CI: 1.04–1.32), major bleeding (HR: 1.16, 95% CI: 1.03–1.29), and death (HR: 1.21, 95% CI: 1.03–1.38) compared with on-label dosing. Furthermore, over-dosing of DOACs increased the risk of stroke/systematic embolism (HR: 1.16; 95% CI: 1.00–1.33) and major bleeding events (HR: 1.18; 95% CI: 1.00–1.37) in Asian patients.Conclusion: A reduced dose of DOACs might be safely and effectively used in clinical practice, especially in Asian patients, whereas high-dose DOACs might not be well tolerated by Asian patients.

scholarly journals Control Of Anticoagulation Therapy in Atrial Fibrillation (COAT-AF Study) in Real Clinical Practice

2020 ◽  
Vol 16 (1) ◽  
pp. 19-23
Author(s):  
A. A. Zarudsky ◽  
A. A. Gavrilova ◽  
Т. S. Filinichenko
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
First Episode ◽  
Exclusion Criteria ◽  
Cardiology Department ◽  
International Normalization Ratio ◽  
Real Clinical Practice

Aim. To study the frequency of prescribing anticoagulant therapy in outpatients with AF in accordance with clinical guidelines.Material and methods. Control Of Anticoagulation Therapy in Atrial Fibrillation (COAT-AF) observational study was conducted at the Saint Joasaph Belgorod Regional Clinical Hospital from January 1, 2016 to December 31, 2017. Patients with AF represented 15.5% of all patients admitted to cardiology department N1. 429 patients were included into the study: 203 women, 226 men; aged of 62.55±11.12 years. Exclusion criteria were mitral stenosis, mechanic prosthetic valve, first episode of AF. CHA2DS2-VASc score was used in all patients for calculation the risk of ischemic stroke and systemic thromboembolism. For patients that were treated by warfarin international normalization ratio (INR) was assessed at admission and discharge from the hospital.Results. From 429 patients 35 had 1 point according to the CHA2DS2-VASc scale, 393 (91.6%) patients had ≥2 points. Only 1 patient had 0 point. Therefore, most patients had absolute indications to anticoagulant therapy. At admission 60 (14%) patients received new oral anticoagulants (NOACs), 213 (49.6%) – warfarin, 156 (36.4%) – did not take any oral anticoagulant. Among patients receiving warfarin only 36 (8.4%) had target INR at admission. Therefore, effective anticoagulant therapy was observed only in 22.4% of patients in real clinical practice. Analyzing anticoagulant therapy in 2016 and 2017 we found a significant increase in NOAC prescription from 10.4% in 2016 to 18.9% in 2017 (p=0.0193).Conclusion. Our data reflects important gaps of anticoagulant therapy in real clinical practice. We compare our results with other Russian registries that included AF-patients. Data at admission and discharge suggests that there are great possibilities for optimization of anticoagulant therapy mainly with NOACs.

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