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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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[What Are the Realities of Prescription and Control of Antithrombotic Therapy in Atrial Fibrillation in Outpatient

R M Linchak1, O G Kompaniets1, A M Nedbaykin1

  • 11National Research Center for Preventive Medicine, Moscow, Russia; 2Kuban State Medical University, Krasnodar, Russia; 3Cardiologic Dispensary of Bryansk Region, Bryansk, Russia.

Kardiologiia
|March 16, 2017
PubMed

Insights

Anticoagulant use for stroke prevention in Russian atrial fibrillation (AF) patients is low, with suboptimal warfarin monitoring. Effective anticoagulation is achieved in only 12.6% of warfarin users.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Context:

  • Nonvalvular atrial fibrillation (AF) poses a high risk for stroke and systemic embolism.
  • Ambulatory care settings in Russia were examined for antithrombotic prescribing patterns.
  • Patient documentation from 648 outpatients across Moscow, Krasnodar, and Bryansk was analyzed.

Purpose:

  • To evaluate the utilization of anticoagulants and antiplatelet agents in Russian AF patients.
  • To assess the quality of anticoagulation control, particularly with warfarin therapy.
  • To identify gaps in antithrombotic management for stroke prevention in AF.

Summary:

  • Overall anticoagulant use in high-risk AF patients was low (30.9%), with novel oral anticoagulants (NOACs) used in only 5.7%.
  • A significant proportion received antiplatelet therapy (53.6%) or no antithrombotic treatment (13.4%).
  • Among warfarin users, only 19.6% monitored international normalized ratio (INR) monthly. Of those with regular monitoring, only 44% maintained INR within the therapeutic range for over 60% of the time, resulting in effective anticoagulation for only 12.6%.

Impact:

  • Findings highlight a critical need to improve anticoagulant prescribing and monitoring for stroke prevention in AF patients in Russia.
  • Suboptimal warfarin management and low NOAC use suggest potential for increased stroke risk in this population.
  • The study underscores the importance of adherence to guidelines for effective anticoagulation in AF management.

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