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Published on: February 26, 2013
Adequacy of anticoagulation in patients with atrial fibrillation: effect of various parameters
N Cohen1, D Almoznino-Sarafian, I Alon
1Department of Internal Medicine F, Assaf Harofeh Medical Center (affiliated to Sackler School of Medicine, Tel Aviv University), Zerifin, Israel.
Insights
Anticoagulation control in atrial fibrillation patients is suboptimal, with only 42% achieving therapeutic International Normalized Ratio (INR) ranges. Patient involvement improves control, highlighting the need for better anticoagulation management to prevent strokes.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Appropriate anticoagulation is crucial for stroke prevention in chronic atrial fibrillation patients.
- Current anticoagulation practices often fall short of optimal requirements.
Purpose of the Study:
- To evaluate doctor and patient-related factors influencing anticoagulation control quality.
- To assess the adequacy of anticoagulation provided by community physicians.
Main Methods:
- Retrospective study analyzing International Normalized Ratio (INR) values on hospital admission.
- INR values were used as indicators of long-term anticoagulation control.
Main Results:
- Only 42% of 385 patients had therapeutic INR (1.91-4.1).
- Poor control (INR < 1.5) affected 28.3%, suboptimal control (1.51-1.9) 14.1%, and bleeding risk (INR > 4.1) 15.6%.
- Patient involvement improved control; older age (70-80) and absence of heart failure were associated with poorer outcomes. Patients with stroke had lower adequate anticoagulation rates (21% vs. 44.4%).
Conclusions:
- Anticoagulation adequacy in atrial fibrillation patients does not meet recommendations.
- Improved anticoagulation control is necessary and achievable, particularly through patient engagement.
Background:
Despite reported evidence of the vital importance of appropriate anticoagulation in patients with chronic atrial fibrillation for stroke prevention, this treatment modality still lags behind optimal requirements.
Hypothesis:
Our objectives were to evaluate various doctor or patient-related factors that influence quality of control and to assess the adequacy of anticoagulation provided by physicians in the community.
Methods:
In a retrospective study, International Normalized Ratio (INR) values obtained immediately on admission to hospital were considered representative of previous long-term control.
Results:
Only 42% of the relevant 385 patient population fell within the protective anticoagulation range of INR 1.91-4.1. The respective figures for patients with poor (INR < 1.5) or suboptimal (INR 1.51-1.9) control, as well as those whose INR values risked bleeding (INR > 4.1), were 28.3, 14.1, and 15.6%. Patient involvement in treatment positively influenced quality of control. By contrast, age 70-80 years or absence of congestive heart failure negatively affected quality of anticoagulation [p = 0.07, odds ratio (OR), 1.7 (95% confidence interval. 0.94-3.08), p = 0.014, OR, 2.06 (95% confidence interval, 1.15-3.7) respectively]. The percentage of patients admitted with stroke who had been adequately anticoagulated was significantly lower than that of patients who had no stroke (21 vs. 44.4%). Adequacy of anticoagulation in patients with cardiac prosthetic valves was superior compared with the rest of the patient population (56.7 vs. 42% with optimal, and only 14.5 vs. 28.3% with poor anticoagulation, respectively), indicating that under the same conditions a better quality of treatment could be achieved.
Conclusions:
Adequacy of anticoagulation in patients with atrial fibrillation lags behind actual recommendations. Better control is required and achievable.
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