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2.
Rev. esp. cardiol. (Ed. impr.) ; 68(9): 769-776, sept. 2015. tab
Article in Spanish | IBECS | ID: ibc-142621

ABSTRACT

Introducción y objetivos: Conocer la situación actual del control de la anticoagulación en pacientes con fibrilación auricular no valvular tratados con antagonistas de la vitamina K en atención primaria en España. Métodos: PAULA es un estudio observacional transversal/retrospectivo y multicéntrico de ámbito nacional. Se incluyó a pacientes con fibrilación auricular no valvular en tratamiento con antagonistas de la vitamina K durante el último año atendidos en las consultas de atención primaria. Se registraron los valores de la razón internacional nomalizada (INR) durante los últimos 12 meses. El grado de control de la anticoagulación se determinó mediante el tiempo en rango terapéutico, tanto por el método directo (mal control < 60%) como por el método de Rosendaal (mal control < 65%).Resultados: Se evaluó a 1.524 pacientes (media de edad, 77,4 ± 8,7 años; el 48,6% mujeres; el 64,2% en fibrilación auricular permanente; media de CHADS2, 2,3 ± 1,2; de CHA2DS2-VASc, 3,9 ± 1,5, y de HAS-BLED, 1,6 ± 0,9). El número medio de determinaciones de la INR registradas por paciente fue 14,4±3,8. El 56,9% de los pacientes tenían un adecuado control por la INR según el método directo y el 60,6% según el método de Rosendaal. En el análisis multivariable, fueron predictores de mal control de la INR el sexo femenino, los hábitos dietéticos que pudieran afectar a la anticoagulación con antagonistas de la vitamina K, la polimedicación y los antecedentes de INR lábil. Conclusiones: Aproximadamente el 40% de los pacientes (el 43,1% por el método directo y el 39,4% por el método de Rosendaal) con fibrilación auricular no valvular anticoagulados con antagonistas de la vitamina K en atención primaria en España presentan un control de la anticoagulación inadecuado durante los 12 meses previos (AU)


Introduction and objectives: To determine the current status of anticoagulation control in patients with nonvalvular atrial fibrillation treated with vitamin K antagonists in the primary care setting in Spain. Methods: The PAULA study was a multicenter cross-sectional/retrospective observational study conducted throughout Spain. The study included patients with nonvalvular atrial fibrillation who had been receiving vitamin K antagonist therapy during the past year and were attended at primary care centers. International normalized ratio (INR) values over the past 12 months were recorded. The degree of anticoagulation control was defined as the time the patient had remained within the therapeutic range and was determined by both the direct method (poor control < 60%) and by the Rosendaal method (poor control < 65%). Results: The study assessed 1524 patients (mean age, 77.4 8.7 years; 48.6% women; 64.2% in permanent atrial fibrillation; CHADS2 mean, 2.3 1.2; CHA2DS2-VASc, 3.9 1.5, and HAS-BLED, 1.6 0.9). The mean number of INR readings recorded per patient was 14.4 3.8. A total of 56.9% of patients had adequate INR control according to the direct method and 60.6% according to the Rosendaal method. The multivariate analysis identified the following predictors for poor INR control: female sex, dietary habits potentially affecting anticoagulation with vitamin K antagonists, multidrug therapy, and a history of labile INR. Conclusions: Approximately 40% of patients (43.1% by the direct method and 39.4% by the Rosendaal method) with nonvalvular atrial fibrillation who were receiving anticoagulation therapy with vitamin K antagonists in primary care in Spain had poor anticoagulation control during the previous 12 months (AU)


Subject(s)
Humans , Vitamin K/antagonists & inhibitors , Atrial Fibrillation/drug therapy , Anticoagulants/administration & dosage , Myocardial Infarction/prevention & control , International Normalized Ratio , Retrospective Studies , Risk Factors , Primary Health Care/statistics & numerical data
3.
Rev Esp Cardiol (Engl Ed) ; 68(9): 769-76, 2015 Sep.
Article in English | MEDLINE | ID: mdl-26169326

ABSTRACT

INTRODUCTION AND OBJECTIVES: To determine the current status of anticoagulation control in patients with nonvalvular atrial fibrillation treated with vitamin K antagonists in the primary care setting in Spain. METHODS: The PAULA study was a multicenter cross-sectional/retrospective observational study conducted throughout Spain. The study included patients with nonvalvular atrial fibrillation who had been receiving vitamin K antagonist therapy during the past year and were attended at primary care centers. International normalized ratio (INR) values over the past 12 months were recorded. The degree of anticoagulation control was defined as the time the patient had remained within the therapeutic range and was determined by both the direct method (poor control < 60%) and by the Rosendaal method (poor control < 65%). RESULTS: The study assessed 1524 patients (mean age, 77.4 ± 8.7 years; 48.6% women; 64.2% in permanent atrial fibrillation; CHADS2 mean, 2.3 ± 1.2; CHA2DS2-VASc, 3.9 ± 1.5, and HAS-BLED, 1.6 ± 0.9). The mean number of INR readings recorded per patient was 14.4 ± 3.8. A total of 56.9% of patients had adequate INR control according to the direct method and 60.6% according to the Rosendaal method. The multivariate analysis identified the following predictors for poor INR control: female sex, dietary habits potentially affecting anticoagulation with vitamin K antagonists, multidrug therapy, and a history of labile INR. CONCLUSIONS: Approximately 40% of patients (43.1% by the direct method and 39.4% by the Rosendaal method) with nonvalvular atrial fibrillation who were receiving anticoagulation therapy with vitamin K antagonists in primary care in Spain had poor anticoagulation control during the previous 12 months.


Subject(s)
Anticoagulants/administration & dosage , Atrial Fibrillation/complications , Blood Coagulation/drug effects , Primary Health Care/statistics & numerical data , Stroke/prevention & control , Aged , Atrial Fibrillation/blood , Cross-Sectional Studies , Dose-Response Relationship, Drug , Female , Follow-Up Studies , Humans , Incidence , Male , Retrospective Studies , Risk Factors , Spain/epidemiology , Stroke/epidemiology , Stroke/etiology , Time Factors , Treatment Outcome , Vitamin K/antagonists & inhibitors
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