Medicina clinica · 2025
Management of anticoagulation and direct oral ancticoagulants in patients with atrial fibrillation treated in Spanish Internal Medicine outpatient clinics.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Giner-Galvañ Vicente, Quirós-López Raúl, Abellán-Martínez Javier, Caballero-Martínez Fernando, Monge-Martín Diana, Neria Fernando, Camafort-Babkowski Miguel
Аннотация
BACKGROUND: Patients with atrial fibrillation (AF) attending Spanish Internal Medicine outpatient clinics (SIMOs) are frequently older, and DOACs are underused.
OBJECTIVE: To assess how anticoagulation and DOACs (direct oral anticoagulants) are applied in patients with AF in the SIMOs.
METHODS: Analysis of the use and opinions about anticoagulants in patients with AF attending the SIMOs in a multicenter, nationwide, retrospective study including 900 patients and 183 physicians.
RESULTS: 96.1% of the patients were anticoagulated, 55% with DOACs. One-third on vitamin K antagonists (VKA) were not within the therapeutic range. DOAC use was higher in patients with shorter duration of AF (p<0.001), better kidney function (p<0.001), and short-term persistent (p=0.035) or paroxysmal AF (p=0.012). DOAC switch indication was met by 32.1% of those on VKA (72% because of out of control range). Although "administrative barriers" (38%), "frailty" (21%); "polypharmacy" (19%) and "very advanced age" (18%) were the main limitations to DOAC prescription in opinion of the physicians, validated scales were seldom used to assess basal functional status.
CONCLUSIONS: More than one-third of patients with AF on VKA treated in the SIMOs should be switched to DOACs. Administrative limitations and poor functional status are the main difficulties for it. Validated scales are rarely used to measure functional basal status.
OBJECTIVE: To assess how anticoagulation and DOACs (direct oral anticoagulants) are applied in patients with AF in the SIMOs.
METHODS: Analysis of the use and opinions about anticoagulants in patients with AF attending the SIMOs in a multicenter, nationwide, retrospective study including 900 patients and 183 physicians.
RESULTS: 96.1% of the patients were anticoagulated, 55% with DOACs. One-third on vitamin K antagonists (VKA) were not within the therapeutic range. DOAC use was higher in patients with shorter duration of AF (p<0.001), better kidney function (p<0.001), and short-term persistent (p=0.035) or paroxysmal AF (p=0.012). DOAC switch indication was met by 32.1% of those on VKA (72% because of out of control range). Although "administrative barriers" (38%), "frailty" (21%); "polypharmacy" (19%) and "very advanced age" (18%) were the main limitations to DOAC prescription in opinion of the physicians, validated scales were seldom used to assess basal functional status.
CONCLUSIONS: More than one-third of patients with AF on VKA treated in the SIMOs should be switched to DOACs. Administrative limitations and poor functional status are the main difficulties for it. Validated scales are rarely used to measure functional basal status.