Preview

Rational Pharmacotherapy in Cardiology

Advanced search

ANTICOAGULANT THERAPY IN EVERYDAY CLINICAL PRACTICE: DATA OF THE RETROSPECTIVE CROSS-SECTIONAL STUDY

https://doi.org/10.20996/1819-6446-2015-11-2-116-123

Full Text:

Abstract

Aim. To study the structure and incidence of the in-hospital anticoagulants prescription in patients at high risk of thromboembolic events (TEE) and to evaluate clinical characteristics of anticoagulated patients (by the example of the University Clinical Hospital (UCH) №1 of I.M. Sechenov First Moscow State Medical University (FMSMU).

Material and methods. The cross-sectional retrospective study held in UCH №1 of the FMSMU, enrolled 677 patients with atrial fibrillation (AF) for whom the prevention of TEE was indicated.

Results. Of 677 analyzed cases (women 70%, men 30%) only 61% of the patients received appropriate anticoagulant therapy. Warfarin was prescribed in 73% of the cases, of them unsatisfactory international normalized ratio (INR) control (time in therapeutic range less than 60%) was revealed in 79%. 8.45% of the vitamin K antagonist treated patients developed hemorrhagic complications. 16% of the patients received novel oral anticoagulants (dabigatran – 14%, rivaroxaban – 2%). Bleeding was fixed in 4.2% of the dabigatran treated patients and in 14.3% - in case of rivaroxaban therapy.

Conclusion. More than a third of non-valvular AF patients receive inadequate antithrombotic therapy in routine clinical practice. 75% of the anticoagulated patients are prescribed the vitamin K antagonists (typically warfarin) as a traditional anticoagulant. At that, only in 21.7% of the patients receiving vitamin K antagonists, this therapy may be considered adequate. Low incidence rate of the novel oral anticoagulants prescription despite the advantages of such treatment also calls attention.

About the Authors

V. A. Sulimov
I.M. Sechenov First Moscow State Medical University
Russian Federation

MD, PhD, Professor, Head of Chair of Faculty Therapy N 1, Department of General Medicine

Trubetskaya ul. 8-2, Moscow, 119991 Russia


D. A. Napalkov
I.M. Sechenov First Moscow State Medical University
Russian Federation

MD, PhD, Professor of the same Chair

Trubetskaya ul. 8-2, Moscow, 119991 Russia



A. A. Sokolova
I.M. Sechenov First Moscow State Medical University
Russian Federation

MD, Cardiologist of Treatment and Diagnostic Unit of the University Clinical Hospital №1

Trubetskaya ul. 8-2, Moscow, 119991 Russia


A. V. Jilenko
I.M. Sechenov First Moscow State Medical University
Russian Federation

MD, Cardiologist of the same Unit

Trubetskaya ul. 8-2, Moscow, 119991 Russia



O. S. Anikina
I.M. Sechenov First Moscow State Medical University
Russian Federation

MD, Resident Doctor of Chair of Faculty Therapy N 1, Department of General Medicine

Trubetskaya ul. 8-2, Moscow, 119991 Russia


References

1. Boytsov S.A., Martsevich S.Yu., Kutishenko N.P. et al. Registries in cardiology: the main principals of conduction and real possibilities. Cardiovascular Therapy and Prevention 2013; 12(1): 4-9. Russian (Бой-цов С.А., Марцевич С.Ю., Кутишенко Н.П., и др. Регистры в кардиологии: основные правила про-ведения и реальные возможности. Кардиоваскулярная Терапия и Профилактика 2013; 12(1): 4-9).

2. Camm AJ, Kirchhof P, Lip GY et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC) European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery. Eur Heart J 2010; 31: 2369-429.

3. Sulimov V.A., Napalkov D.A., Sokolova A.A. Comparative efficacy and safety of new oral anticoagulants. Rational Pharmacotherapy in Cardiology 2013; 9(3): 287-92. Russian (Сулимов В.А., Напалков Д.А., Соколова А.А. Сравнительная эффективность и безопасность новых пероральных антикоагулянтов. Рациональная Фармакотерапия в Кардиологии 2013; 9(3): 287-92).

4. ESC Guidelines. Guidelines for the management of atrial fibrillation. Eur Heart J 2010; 31: 2369-429.

5. Naccarelli GV, Varker H, Lin J, Schulman KL . Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol 2009; 104: 1534-1539.

6. Boytsov S.A., Podlesov A.M., Egorov D.F. Atrial fibrillation. SPb: Elbi-SPB; 2001. Russian (Бойцов С.А., Подлесов А.М., Егоров Д.Ф. Мерцательная аритмия. СПб.: Элби-СПБ; 2001).

7. Kushakovsky M.S. Heart arrhythmias: guidelines for doctors. Third edition. SPb: Foliant; 2007. Russian (Кушаковский М.С. Аритмии сердца: руководство для врачей. 3-е издание. СПб.: Фолиант; 2007).

8. Serdechnaya E.V., Tatarsky B.A., Istomina T.A. Epidemiology of atrial fibrillation. Human being Ecology 2009; 11: 48–54. Russian (Сердечная Е.В., Татарский Б.А., Истомина Т.А. Эпидемиология фиб-рилляции предсердий. Экология Человека 2009; 11: 48-54).

9. Novikova N.A., Sorokina E.G., Gilyarov M.Yu., Sarkisova N.D. Influnce of gender factors on antithrombotic treatment principles in patients with atrial fibrillation. Vestnik Aritmologii 2009; 58: 21-4. Russian (Но-викова Н.А., Сорокина Е.Г., Гиляров М.Ю., Саркисова Н.Д. Влияние гендерных факторов на ха-рактер антитромботической терапии у пациентов с фибрилляцией предсердий. Вестник Арит-мологии 2009; 58: 21-4).

10. Go A.S., Hylek E.M., Phillips K.A., et al. Prevalence of Diagnosed Atrial Fibrillation in Adults: National Implications for Rhythm Management and Stroke Prevention: the AnTicoagulation and Risk Factors In Atrial Fibrillation (ATRIA) Study. J Am Med Assoc 2001; 285: 2370-5.

11. Loukianov M.M., Boytsov S.A., Yakushin S.S. et al. Diagnostics, treatment, cardiovascular pathology and concomitant diseases in patients with diagnosis of “atrial fibrillation” in outpatient practice settings (in accordance to the Registry of Cardiovascular Diseases – RECVASA). Rational Pharmacotherapy in Cardiology 2014; 10 (4): 366-77. Russian (Лукьянов М.М., Бойцов С.А., Якушин С.С., и др. Диагностика, лечение, сердечно-сосудистая патология и сопутствующие заболевания у боль-ных с диагнозом «фибрилляция предсердий» в условиях реальной амбулаторно-поликлини-ческой практики (по данным РЕгистра КардиоВАскулярных ЗАболеваний РЕКВАЗА). Рациональная Фармакотерапия в Кардиологии 2014; 10 (4): 366-77).

12. Drozdova E.A. Secondary stroke prevention in patients with nonvalvular atrial fibrillation from clinician’s point of view. Rational Pharmacotherapy in Cardiology 2014; 10 (2): 179-83. Russian (Дроз-дова Е.А. Вторичная профилактика инсульта у пациентов с неклапанной формой фибрилля-ции предсердий с точки зрения клинициста. Рациональная Фармакотерапия в Кардиологии 2014; 10 (2): 179-83).

13. Graifer I.V., Kuvshinova L.E., Dolotovskaya P.V. et al. Thromboembolic complications risk and antithrombotic therapy in hospitalized patients with permanent or recurrent atrial fibrillation in real clinical practice. Rational Pharmacotherapy in Cardiology 2012; 8 (5): 675-80. Russian (Грайфер И.В., Кувшино-ва Л.Е., Долотовская П.В., и др. Риск тромбоэмболических осложнений и антитромботическая терапия у госпитализированных больных постоянной и рецидивирующей фибрилляцией пред-сердий в реальной клинической практике. Рациональная Фармакотерапия в Кардиологии 2012; 8 (5): 675-80).

14. Amin A, Deitelzweig S, Jing Y, et al. Estimation of the impact of warfarin’s time-in-therapeutic range on stroke and major bleedings rates and its influence on the medical cost avoidance associated with novel oral anticoagulant use-learnings from ARISTOTLE, ROCKET-AF, and RE-LY trials. J Thromb Thrombolysis 2014; 38 (2): 150-9.


For citation:


Sulimov V.A., Napalkov D.A., Sokolova A.A., Jilenko A.V., Anikina O.S. ANTICOAGULANT THERAPY IN EVERYDAY CLINICAL PRACTICE: DATA OF THE RETROSPECTIVE CROSS-SECTIONAL STUDY. Rational Pharmacotherapy in Cardiology. 2015;11(2):116-123. (In Russ.) https://doi.org/10.20996/1819-6446-2015-11-2-116-123

Views: 488


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)