Liječnički vjesnik, Vol. 135 No. 5-6, 2013.
Izvorni znanstveni članak
ANTICOAGULANT THERAPY IN PATIENTS WITH PERMANENT ATRIAL FIBRILLATION – EVIDENCE BASED MEDICINE AND CLINICAL PRACTICE
Ivona Božić
Vesna Čapkun
Dorotea Božić
Svjetlana Karabuva
Krešimir Čaljkušić
Gorana Trgo
Vedran Carević
Damir Fabijanić
Sažetak
Objective of study was to assess the concordance of the tromboprophylactic treatment in patients with permanent atrial fibrillation (pAF) with guidelines of the European Society of Cardiology. Prospective cross-sectional study consecutivelly included 674 patients (400 Š59%Ć male) discharged from cardiology department with the diagnosis pAF. The thromboembolic risk (TE) has been established according to CHA2DS2-VASc score, whereas the bleeding risk has been assessed according to HAS-BLED score. 578 (86%) belonged to the group of high, 57 (8%) to the group of moderate, and 39 (6%) patients to the group of low TE risk. 601 (89%) patients received thromboprophylaxis: 310 (46%) warfarin, 258 (38%) acetylsalicylic acid, and 33 (5%) patients clopidogrel. Warfarin has been prescribed to 47% of patients with high, 49% of patients with moderate and to 26% of patients with low TE risk (P=0.03). Acetylsalicylic acid (ASA) has equally been prescribed to patients of all TE risk groups: low, moderate and high (39% vs. 39% vs. 38%; P=0.998). ASA (P<0.001) and warfarin (P=0.007) have been used more frequently in the group of patients with high bleeding risk, in which the same incidence of warfarin and ASA administration has been registered (53% vs. 47%; P=0.416). Age ³75 has been an independent predictor of non-administration (OR 1.7; 95% CI 1.2–2.4; P=0.003), whereas the history of stroke was for warfarin administration (OR 0.47; 95% CI 0.29–0.76; P=0.002). In prescribing thromboprophylaxis to patients with pAF, cardiologists do not observe the recommended clinical guidelines. Despite nonexistence of contraindications, a significant number of patients with high TE risk has not been administered warfarin. At the same time, warfarin has been administered to the patients with low TE risk, exposing them unnecessarily to the undesired effect of anticoagulant treatment.
Ključne riječi
Atrial fibrillation – complications, drug therapy; Risk assessment – methods; Anticoagulants – therapeutic use, adverse effects; Cerebral infarction – etiology, prevention and control; Thromboembolism – etiology, prevention and control; Hemorrhage – etiology, prevention and control; Warfarin – therapeutic use, adverse effects; Aspirin – therapeutic use, adverse effects; Evidence – based medicine
Hrčak ID:
172473
URI
Datum izdavanja:
27.6.2013.
Posjeta: 1.612 *