Background Non-valvular atrial fibrillation (NVAF) is the most common cardiac arrhythmia in clinical practice. In Spain, the stipulated recommendations to select anticoagulants are: use of direct oral anticoagulants (DOAC) in the case of poor INR control, intolerance to vitamin-K antagonists or adverse events, impediment to INR controls or patients with a stroke disease.
Purpose Our aim was to analyse the treatment in chronic complex patients (PCC) with NVAF admitted to the internal medicine service (MI) and other items related to NVAF in these patients.
Material and methods Transversal study of PCC diagnosed with NVAF admitted to the MI, with two or more chronic diseases according to the Charlson index. The study period was 7 months during the rotation of two hospital pharmacists in the MI. Epidemiological, clinical and pharmacological data were analysed. Data was treated in a codified way to respect confidentiality.
Results Seventy-three PCC were evaluated. The median age was 83 years (66–95), 38 females (52.1%). Thirty-two patients (43.8%) had paroxysmal AF, 28 patients (38.3%)>1 year persistent AF, 12 patients (16.4%)>7 days persistent AF and one patient (1.3%) with origin uncertain AF. The most frequently associated risk factors were: hypertension (90.4%), dyslipidaemia (65.7%), diabetes mellitus (61.6%) and heart failure (60.2%).
Sixty-one patients (83.6%) were treated with oral anticoagulants; of whom 19 were also anti-aggregated. Of the 61 anticoagulated patients, 23 (37.7%) were treated with DOAC (10 apixaban, seven dabigatran, five rivaroxaban, one edoxaban). The remaining 38 (62.3%) were treated with anti-vitamin K. On admission, 12 (31.6%) patients with anti-vitamin K treatments were in the therapeutic range, with a median INR of 2.4 (2.05–3), compared to 13 (34.2%) patients who were under-dosed and 13 (34.2%) supradosified with a median INR of 1.56 (1–1.9) and 3.4 (3.2–12) respectively. One-hundred per cent of the patients had a CHA2DS2VASc>2 points. The reason for the non-anticoagulation of the 12 patients without treatment was the previous haemorrhages, with HAS-BLEED >3 points.
The main differences between the anticoagulated patients and those without, was the percentage of diabetes mellitus (70.5% vs 41.7%) and heart failure (65.6% vs 33.3%).
Conclusion Our data shows that most of the PCC diagnosed with NVAF were treated with anticoagulants. All patients had CHA2DS2VASc score required for anticoagulant treatment. 37.7% of the patients were being treated with DOAC. Comorbidities observed are in line with other studies conducted in NVAF. The main causes of non-anticoagulation were previous haemorrhages.
References and/or acknowledgements No conflict of interest.
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