scholarly journals 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

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. 

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

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. 

scholarly journals Changes in Antithrombotic Therapy of Atrial Fibrillation in the Hospital in 2011-2012 and 2016-2017 (Pharmacoepidemiological Analysis)

2020 ◽  
Vol 16 (5) ◽  
pp. 686-692
Author(s):  
O. V. Reshetko ◽  
A. V. Sokolov ◽  
N. V. Furman ◽  
V. V. Agapov
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
High Risk ◽  
Antithrombotic Therapy ◽  
Heart Defects ◽  
Oral Anticoagulants ◽  
Prosthetic Heart Valve ◽  
Saratov Region ◽  
Coronary Syndrome ◽  
Risk Of Bleeding

Aim. To study the changes that have occurred in the pharmacotherapy of atrial fibrillation (AF) in the Saratov Region for 5 years by analyzing the antithrombotic therapy of patients who were admitted in a specialized department of the multidisciplinary hospital in Saratov in 2011-2012 and in 2016-2017.Material and methods. A pharmacoepidemiological retrospective study was conducted. The object of the study was the medical records of inpatients (Form 003/y) with the diagnosis “Atrial fibrillation” (ICD-X code I48), that consecutively admitted to the cardiology department of the multidisciplinary hospital in Saratov from January 1, 2011 to December, 31, 2012 (n=211) and from January 1, 2016 to December, 31, 2017 (n=227). Criteria for inclusion in the study: patients over 18 years of age, established diagnosis of non-valvular AF of ischemic genesis. Exclusion criteria from the study: non-ischemic cardiomyopathy, thyrotoxicosis, congenital heart defects, rheumatic heart damage, acute coronary syndrome, endocarditis, myocarditis, pericarditis, pulmonary thromboembolism, the presence of prosthetic heart valve. Pharmacoepidemiological analysis was carried out for the drugs prescribed during hospitalization and given by doctors at discharge of patients from the hospital. The risk of ischemic stroke was assessed using the CHA2DS2-VASc score, and the risk of bleeding – according to the HAS-BLED score.Results. When analyzing the risk of ischemic stroke, it was found that 100% of patients in 2011-2012 years and 98.2% in 2016-2017 years had indications for the prescription of oral anticoagulants (OAСs). In 2011-2012 there were no patients with a low risk of stroke (CHA2DS2-VASc=0). High risk of bleeding (HAS-BLED≥3) occurred in 4.7% of patients in 2011-2012 and in 10.6% in 2016-2017, however, due to the high risk of stroke, the refusal to prescribe OAC in these patients was inappropriate in accordance with the recommendations for the treatment of AF. In the group of patients with CHA2DS2-VASc=0 in 2016-2017 antiplatelet therapy was prescribed in 100% at the hospital stage and at discharge, which contradicts the guidelines, according to which antithrombotic therapy is not recommended to patients with CHA2DS2-VASc=0. In patients with CHA2DS2-VASc=1, a low percentage of anticoagulants prescription was noted. In 2016-2017 OACs were prescribed only in 12.5% of patients at all stages of observation. In 2011-2012 OAC alone was prescribed only to 1 person (20%) at the hospital stage, which does not comply with modern guidelines for the treatment of patients with AF, according to which patients with a risk score CHA2DS2-VASc=1 are recommended to receive OACs in the absence of contraindications. OACs prescription in group CHA2DS2-VASc≥2 occurred only in 15% of patients in 2011-2012 and in a third of patients in 2016-2017 (p<0.05). The frequency of isolated use of OACs significantly increased in 2016-2017 compared to 2011-2012 mainly due to the increase in the spectrum of direct OACs (DOACs) (p<0.05).Conclusion. For 5 years there have been significant changes in the antithrombotic therapy of AF in the Saratov Region. The frequency of prescribing OACs according to indications has increased mainly due to the introduction of the DOACs into clinical practice. However, prevention of stroke remains insufficient.

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

2021 ◽  
Vol 102 (4) ◽  
pp. 439-445
Author(s):  
N K Kinderbaeva ◽  
K Bazira ◽  
N M Karabekova ◽  
R M Mamatova ◽  
Zh Asel ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Anticoagulant Therapy ◽  
Antithrombotic Therapy ◽  
Oral Anticoagulants ◽  
International Normalized Ratio ◽  
Average Score ◽  
The Third ◽  
Number Of Patients ◽  
Specialized Team

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.

scholarly journals Antithrombotic therapy in patients with atrial fibrillation and percutaneous coronary intervention: what has changed in the guidelines in 2020?

2020 ◽  
pp. 56-64
Author(s):  
E. P. Panchenko
Keyword(s):  
Atrial Fibrillation ◽  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Stent Thrombosis ◽  
Antithrombotic Therapy ◽  
Oral Anticoagulants ◽  
Coronary Intervention ◽  
Antiplatelet Drug ◽  
Risk Of Bleeding ◽  
Percutaneous Coronary

The article presents an analytical review of the studies aimed at determining the optimal antithrombotic therapy in patients with atrial fibrillation undergoing elective or emergency percutaneous coronary intervention (PCI) due to the development of acute coronary syndrome (ACS). The results of the WOEST study are analysed. This study was the first to demonstrate an opportunity to safely discontinue administration of aspirin as part of the multicomponent antithrombotic therapy that included warfarin as an anticoagulant. Three studies were analysed - PIONEER AF-PCI, RE-DUAL-PCI and AUGUSTUS, where direct oral anticoagulants (DOACs) - rivaroxaban, dabigatran and apixaban were used as anticoagulants as part of the multicomponent therapy. The results of these studies formed the backbone of the updated European guidelines for the diagnosis and treatment of atrial fibrillation, 2020. The guidelines offer to divide patients with AF and ACS, who require multicomponent antithrombotic therapy, into two categories. The first group includes AF patients with uncomplicated PCI without a high risk of stent thrombosis, as well as patients with a risk of bleeding that prevails over the risk of stent thrombosis. The second category of patients, in contrast, is characterized by a high risk of stent thrombosis, which prevails over the risk of bleeding. In the absence of contraindications, the patients of both categories should choose DOAC as an anticoagulant and be prescribed clopidogrel as a P2Y12 inhibitor for 12 months. In AF patients with uncomplicated PCI without a high risk of stent thrombosis, as well as in patients with a risk of bleeding, which prevails over the risk of stent thrombosis, the period of treatment with the second antiplatelet drug (aspirin) should belimited to the hospital stay. Patients at increased risk of stent thrombosis and reduced risk of bleeding can extend the aspirin therapy for 1 month. The approaches to the choice of the duration and composition of the multicomponent antithrombotic therapy in AF patients taking oral anticoagulants after elective PCI are similar to those in ACS patients, except for the duration of clopidogrel therapy, which is reduced to 6 months in all patients.

Abstract 14763: Patients With a Perceived High-bleeding Risk in a Randomized Controlled Trial of Alert-based Computerized Decision Support for Stroke Prevention in Atrial Fibrillation: An Af-Alert Substudy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Gregory Piazza ◽  
Shelley Hurwitz ◽  
Brett Carroll ◽  
Samuel Z Goldhaber
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Stroke Prevention ◽  
Antithrombotic Therapy ◽  
Controlled Trial ◽  
Bleeding Risk ◽  
Computerized Decision Support ◽  
Risk Of Bleeding ◽  
Randomized Controlled ◽  
Risk For Bleeding

Introduction: A perceived increased risk of bleeding is one of the most frequent reasons for failure to prescribe anticoagulation for stroke prevention in atrial fibrillation (AF). We previously conducted a randomized controlled trial of alert-based computerized decision support (CDS) to increase prescription of antithrombotic therapy in 458 high-risk hospitalized patients with AF who were not being anticoagulated. Hypothesis: We hypothesized that patients with a perceived high risk for bleeding would have a similar HAS-BLED score and rate of major and clinically-relevant non-major bleeding. Methods: To determine the clinical characteristics and outcomes of these patients determined to be high-risk for bleeding, we analyzed the 248 patients in the alert group. Results: A perceived high risk of bleeding was the most common reason (77%) for omitting antithrombotic therapy. Median HAS-BLED scores were similar in these patients compared with those who were not deemed to have an increased bleeding risk (3 vs. 3, p=0.44). Despite being categorized as too high-risk for bleeding to receive antithrombotic therapy for stroke prevention at the time of the alert, nearly 12% of these patients were ultimately prescribed anticoagulation over the ensuing 90 days. The frequency of major and clinically-relevant non-major bleeding was similar between the two groups. Conclusions: In conclusion, a perceived high risk of bleeding was the most common reason for failure to prescribe antithrombotic therapy after the CDS alert. History of a prior bleeding event or underlying bleeding disorder was not reflected in a higher HAS-BLED score. Implementation of an alert-based CDS with specific attention to assessment of bleeding risk and mitigation warrants further study to encourage adherence to evidence-based clinical practice guideline recommendations for stroke prevention in AF.

Oral anticoagulants in atrial fibrillation with valvular heart disease and bioprosthetic heart valves

Heart ◽  
2019 ◽  
Vol 105 (18) ◽  
pp. 1432-1436 ◽  
Author(s):  
Aaqib H Malik ◽  
Srikanth Yandrapalli ◽  
Wilbert S Aronow ◽  
Julio A Panza ◽  
Howard A Cooper
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Major Bleeding ◽  
Valvular Heart Disease ◽  
Heart Valves ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Cardiac Events ◽  
Increased Risk ◽  
Randomised Controlled

ObjectiveCurrent guidelines endorse the use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF). However, little is known about their safety and efficacy in valvular heart disease (VHD). Similarly, there is a paucity of data regarding NOACs use in patients with a bioprosthetic heart valve (BPHV). We, therefore, performed a network meta-analysis in the subgroups of VHD and meta-analysis in patients with a BPHV.MethodsPubMed, Cochrane and Embase were searched for randomised controlled trials. Summary effects were estimated by the random-effects model. The outcomes of interest were a stroke or systemic embolisation (SSE), myocardial infarction (MI), all-cause mortality, major adverse cardiac events, major bleeding and intracranial haemorrhage (ICH).ResultsIn patients with VHD, rivaroxaban was associated with more ICH and major bleeding than other NOACs, while edoxaban 30 mg was associated with least major bleeding. Data combining all NOACs showed a significant reduction in SSE, MI and ICH (0.70, [0.57 to 0.85; p<0.001]; 0.70 [0.50 to 0.99; p<0.002]; and 0.46 [0.24 to 0.86; p<0.01], respectively). Analysis of 280 patients with AF and a BPHV showed similar outcomes with NOACs and warfarin.ConclusionsNOACs performed better than warfarin for a reduction in SSE, MI and ICH in patients with VHD. Individually NOACs performed similarly to each other except for an increased risk of ICH and major bleeding with rivaroxaban and a reduced risk of major bleeding with edoxaban 30 mg. In patients with a BPHV, results with NOACs seem similar to those with warfarin and this needs to be further explored in larger studies.

scholarly journals ASPECTS OF MULTICOMPONENT THERAPY AND PERIOPERATIVE TACTICS IN A PATIENT WITH ATRIAL FIBRILLATION RECEIVING RIVAROXABAN THERAPY. CLINICAL OBSERVATION

2019 ◽  
pp. 62-71
Author(s):  
O. A. Zemlyanskaya ◽  
E. S. Kropacheva
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Life Expectancy ◽  
Antithrombotic Therapy ◽  
Clinical Observation ◽  
Oral Anticoagulants ◽  
Point Of View ◽  
Systemic Embolism ◽  
Thromboembolic Risk ◽  
Practical Point

The use of modern oral anticoagulants is associated with a significant reduction in the risk of stroke and systemic embolism in patients with atrial fibrillation, and thus with an increase in the life expectancy of patients. That is why multicomponent therapy and perioperative tactics are actual during prolonged anticoagulation, the aspects of which seem to be one of the most difficult from the practical point of view. This clinical observation is an illustration of the management of a patient with atrial fibrillation at high thromboembolic risk who is receiving Rivaroxaban therapy and who has indications for catheter ablation and multicomponent antithrombotic therapy.

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