RESUMO
Fundamento y objetivo: Evaluar en la práctica clínica el cumplimiento de las recomendaciones del Informe de Posicionamiento Terapéutico (IPT) de la Agencia Española de Medicamentos y Productos Sanitarios sobre el tratamiento con anticoagulantes orales en pacientes≥75 años con fibrilación auricular no valvular (FANV) atendidos en unidades de Medicina Interna en España. Pacientes y métodos: Estudio observacional, transversal y multicéntrico, en el que se incluyeron 837 pacientes≥75 años con FANV en tratamiento estable con anticoagulantes orales durante los 3 meses previos a la inclusión y que hubiesen iniciado dicho tratamiento antes de comenzar el período de inclusión. Resultados: La edad media fue de 83,0±5,0 años, el CHADS2 medio 3,2±1,2, el CHA2DS2-VASc 5,0±1,4 y el HAS-BLED 2,1±0,9. El 70,8% de los pacientes estaba en tratamiento con antagonistas de la vitamina K (AVK) y el resto con anticoagulantes orales de acción directa (ACOD). El 65,6% de los pacientes con AVK no siguieron las recomendaciones del IPT frente al 43,0% de los pacientes con ACOD (p<0,0001). En el caso de los pacientes con AVK, el motivo principal para ser considerado como no adecuado fue presentar un mal control de la anticoagulación y no cambiar a un ACOD, mientras que en el caso de los ACOD fue recibir una dosis inadecuada según el IPT. Conclusiones: En un porcentaje elevado de pacientes ancianos con FANV anticoagulados en España no se siguen las recomendaciones realizadas por el IPT, especialmente con los AVK, al no realizarse el cambio a ACOD a pesar de un tiempo en rango terapéutico inadecuado
Background and objective: To evaluate the adherence to the recommendations in clinical practice performed by the Therapeutic Positioning Report (TPR) of the Spanish Agency of Medicines and Sanitary Products about the treatment with oral anticoagulants in patients aged≥75 years old with nonvalvular atrial fibrillation (NVAF) treated in Internal Medicine departments in Spain. Patients and methods: Observational, cross-sectional and multicenter study in which 837 patients aged≥75 years old with NVAF, with stable treatment with oral anticoagulants at least 3 months before inclusion, and that had started treatment with oral anticoagulants before the inclusion period were included. Results: Mean age was 83.0±5.0 years old, mean CHADS2 score 3.2±1.2, mean CHA2DS2-VASc score 5.0±1.4, and mean HAS-BLED score 2.1±0.9. A percentage of 70.8 of patients were treated with vitamin K antagonists (VKA) and the rest of patients with direct oral anticoagulants (DOACs). A percentage of 65.6 of patients treated with VKA did not follow the recommendations made by the TPR compared with 43.0% of patients treated with DOACs (P<.0001). In the case of VKA, the main reason for being considered as not appropriate according to the TPR was having poor control of anticoagulation and not switching to DOACs, whereas in the case of DOACs, it was not receiving the adequate dose according to the TPR. Conclusions: In a high proportion of anticoagulated elderly patients with NVAF in Spain, the recommendations performed by the TPR are not followed, particularly with VKA, since patients are not switched to DOACs despite time in therapeutic range
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Vitamina K/antagonistas & inibidores , Antifibrinolíticos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Estudo Observacional , Estudos Transversais , Anticoagulantes/uso terapêutico , Anticoagulantes/administração & dosagem , IdosoRESUMO
BACKGROUND: Although, by itself, atrial fibrillation is associated with an impairment of quality of life antithrombotic therapy may play a role. OBJECTIVE: To evaluate the satisfaction with anticoagulant treatment in patients with nonvalvular atrial fibrillation who attended internal medicine departments in Spain. METHODS: Patients from two different cross-sectional studies were combined. To measure the satisfaction with anticoagulant treatment, the Anti-Clot-Treatment Scale (ACTS) questionnaire was completed by every patient. A multivariate analysis was performed to determine the variables associated with satisfaction of patients receiving oral anticoagulants. RESULTS: A total of 1,309 patients (mean age 78.5±8.4 years; 49.3% men; CHA2DS2VASC 4.9±1.5; HAS-BLED 2.0±0.9) were included in the study, of whom 902 (68.9%) were taking vitamin K antagonists (VKA) and 407 (31.1%) direct oral anticoagulants (DOACs). Overall, satisfaction with oral anticoagulation was high (ACTS Burdens scale 49.69±9.45; ACTS Benefits scale 11.35±2.61). The perceived burdens with anticoagulant treatment were lower in men, as well as in patients with no dependency, normal renal function, who were not polymedicated, or who had moderate bleeding risk. Among patients taking VKA, those subjects with a lower number of International Normalized Ratio (INR) determinations in the last 6 months or with an optimal time in the therapeutic range exhibited a lower perceived burden. Patients taking DOACs (vs VKA) showed a lower perceived burden with anticoagulation. Benefits with anti-coagulation were higher in men, younger patients, those with no dependency, or low bleeding risk. Perceived benefits were higher in patients taking DOACs (vs VKA). CONCLUSION: Satisfaction with oral anticoagulation was high in patients with nonvalvular atrial fibrillation, who were attending internal medicine departments daily in Spain. Among patients taking VKA, those subjects with a lower number of INR determinations in the last 6 months or with an optimal time in the therapeutic range exhibited a lower perceived burden with anticoagulant therapy. Patients taking DOACs (vs VKA) showed lower perceived burdens and higher perceived benefits with anticoagulation.
RESUMO
BACKGROUND AND OBJECTIVE: To evaluate the adherence to the recommendations in clinical practice performed by the Therapeutic Positioning Report (TPR) of the Spanish Agency of Medicines and Sanitary Products about the treatment with oral anticoagulants in patients aged≥75 years old with nonvalvular atrial fibrillation (NVAF) treated in Internal Medicine departments in Spain. PATIENTS AND METHODS: Observational, cross-sectional and multicenter study in which 837 patients aged≥75 years old with NVAF, with stable treatment with oral anticoagulants at least 3 months before inclusion, and that had started treatment with oral anticoagulants before the inclusion period were included. RESULTS: Mean age was 83.0±5.0 years old, mean CHADS2 score 3.2±1.2, mean CHA2DS2-VASc score 5.0±1.4, and mean HAS-BLED score 2.1±0.9. A percentage of 70.8 of patients were treated with vitamin K antagonists (VKA) and the rest of patients with direct oral anticoagulants (DOACs). A percentage of 65.6 of patients treated with VKA did not follow the recommendations made by the TPR compared with 43.0% of patients treated with DOACs (P<.0001). In the case of VKA, the main reason for being considered as not appropriate according to the TPR was having poor control of anticoagulation and not switching to DOACs, whereas in the case of DOACs, it was not receiving the adequate dose according to the TPR. CONCLUSIONS: In a high proportion of anticoagulated elderly patients with NVAF in Spain, the recommendations performed by the TPR are not followed, particularly with VKA, since patients are not switched to DOACs despite time in therapeutic range.
Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Fidelidade a Diretrizes/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , EspanhaRESUMO
El nevo lipomatoso cutáneo superficial (NLCS) es una anomalía del desarrollo infrecuente, caracterizada por la presencia de tejido adiposo maduro ectópico en la dermis. Puede estar presente al nacer o aparecer en la infancia o adolescencia. Describimos dos casos de NLCS: el primero, un niño de 4 años con una placa hipertricótica en la nalga izquierda, presente desde el nacimiento y el segundo, una niña de 9 años con una placa de aspecto esclerodermiforme en el muslo izquierdo, de aparición en etapa preescolar.
Nevus lipomatosus cutaneous superficialis (NLCS) is a rare developmental anomally characterized by the presence of ectopic mature adipose tissue in the dermis. It may be present at birth, or appear at chilhood or adolescence. We describe two cases of NLCS: the firs one, a 4-year-old child that presented with an hypertrychotic plaque on his left buttock, present from birth and, the second one, a 9-year-old girl with a plaque of sclerodermiform appearance on her left leg, that arise before school time.
