Vivencio Barrios1, Carlos Escobar2, Luis Prieto3, Genoveva Osorio4, José Polo5, José María Lobos6, Diego Vargas7, Nicolás García4. 1. Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain. Electronic address: vivencio.barrios@gmail.com. 2. Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain. 3. Bioestadística Médica, Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain. 4. Departamento Médico, Bayer Hispania S.L., Barcelona, Spain. 5. Centro de Salud Casar de Cáceres, Casar de Cáceres, Cáceres, Spain. 6. Centro de Salud Jazmín, Área 4 de Atención Primaria, Madrid, Spain. 7. Unidad de Hospitalización Polivalente, Hospital de Alta Resolución El Toyo, Hospital de Poniente El Ejido, Almería, Spain.
Abstract
INTRODUCTION AND OBJECTIVES: To determine the current status of anticoagulation control in patients with nonvalvular atrial fibrillation treated with vitamin K antagonists in the primary care setting in Spain. METHODS: The PAULA study was a multicenter cross-sectional/retrospective observational study conducted throughout Spain. The study included patients with nonvalvular atrial fibrillation who had been receiving vitamin K antagonist therapy during the past year and were attended at primary care centers. International normalized ratio (INR) values over the past 12 months were recorded. The degree of anticoagulation control was defined as the time the patient had remained within the therapeutic range and was determined by both the direct method (poor control < 60%) and by the Rosendaal method (poor control < 65%). RESULTS: The study assessed 1524 patients (mean age, 77.4 ± 8.7 years; 48.6% women; 64.2% in permanent atrial fibrillation; CHADS2 mean, 2.3 ± 1.2; CHA2DS2-VASc, 3.9 ± 1.5, and HAS-BLED, 1.6 ± 0.9). The mean number of INR readings recorded per patient was 14.4 ± 3.8. A total of 56.9% of patients had adequate INR control according to the direct method and 60.6% according to the Rosendaal method. The multivariate analysis identified the following predictors for poor INR control: female sex, dietary habits potentially affecting anticoagulation with vitamin K antagonists, multidrug therapy, and a history of labile INR. CONCLUSIONS: Approximately 40% of patients (43.1% by the direct method and 39.4% by the Rosendaal method) with nonvalvular atrial fibrillation who were receiving anticoagulation therapy with vitamin K antagonists in primary care in Spain had poor anticoagulation control during the previous 12 months.
INTRODUCTION AND OBJECTIVES: To determine the current status of anticoagulation control in patients with nonvalvular atrial fibrillation treated with vitamin K antagonists in the primary care setting in Spain. METHODS: The PAULA study was a multicenter cross-sectional/retrospective observational study conducted throughout Spain. The study included patients with nonvalvular atrial fibrillation who had been receiving vitamin K antagonist therapy during the past year and were attended at primary care centers. International normalized ratio (INR) values over the past 12 months were recorded. The degree of anticoagulation control was defined as the time the patient had remained within the therapeutic range and was determined by both the direct method (poor control < 60%) and by the Rosendaal method (poor control < 65%). RESULTS: The study assessed 1524 patients (mean age, 77.4 ± 8.7 years; 48.6% women; 64.2% in permanent atrial fibrillation; CHADS2 mean, 2.3 ± 1.2; CHA2DS2-VASc, 3.9 ± 1.5, and HAS-BLED, 1.6 ± 0.9). The mean number of INR readings recorded per patient was 14.4 ± 3.8. A total of 56.9% of patients had adequate INR control according to the direct method and 60.6% according to the Rosendaal method. The multivariate analysis identified the following predictors for poor INR control: female sex, dietary habits potentially affecting anticoagulation with vitamin K antagonists, multidrug therapy, and a history of labile INR. CONCLUSIONS: Approximately 40% of patients (43.1% by the direct method and 39.4% by the Rosendaal method) with nonvalvular atrial fibrillation who were receiving anticoagulation therapy with vitamin K antagonists in primary care in Spain had poor anticoagulation control during the previous 12 months.
Keywords:
Antagonistas de la vitamina K; Control de la razón internacional normalizada; Fibrilación auricular no valvular; International normalized ratio control; Nonvalvular atrial fibrillation; Rosendaal; Vitamin K antagonists
Authors: Román Freixa-Pamias; Pere Blanch Gràcia; Lluïsa Rodriguez Latre; Antoni Oliva Vicedo; Carmen Alonso Permanyer; Pilar Sánchez Chamero; Elisabet Mena Sebastià; Miriam García Bermúdez; Alberto Cabestrero de Diego; Angels González Guardia; Elena Salas González; Carolina Bosch Carabante; José Manuel Depares López; Mireia Sans Corrales; Juan Francisco Pajares Díaz-Meco; Jordi Vericat Garcia; Maria Jesús Megido Badía; Jordi Vilarasau Farre; Maria Rotllan Terradellas; Angel Jover Blanca Journal: Eur Cardiol Date: 2017-12
Authors: Carmen Suárez Fernández; Luis Castilla-Guerra; Jesus Cantero Hinojosa; Josep Maria Suriñach; Fernando Acosta de Bilbao; Juan José Tamarit; José Luis Diaz Diaz; Jose Luis Hernandez; Antonio Pose; Manuel Montero-Pérez-Barquero; Jaume Roquer; Jaime Gállego; José Vivancos; Jose María Mostaza Journal: Patient Prefer Adherence Date: 2018-02-19 Impact factor: 2.711
Authors: Aníbal García-Sempere; Isabel Hurtado; Daniel Bejarano-Quisoboni; Clara Rodríguez-Bernal; Yared Santa-Ana; Salvador Peiró; Gabriel Sanfélix-Gimeno Journal: PLoS One Date: 2019-02-12 Impact factor: 3.240
Authors: Samantha Wasniewski; Luciano Consuegra-Sánchez; Pablo Conesa-Zamora; Luis García de Guadiana-Romualdo; Pablo Ramos-Ruiz; Marta Merelo-Nicolás; F Guillermo Clavel-Ruipérez; Begoña Alburquerque-González; Federico Soria-Arcos; Juan A Castillo-Moreno Journal: Biomed Res Int Date: 2018-10-17 Impact factor: 3.411
Authors: Carlos Escobar; Xavier Borrás; Ramón Bover Freire; Carlos González-Juanatey; Miren Morillas; Alfonso Valle Muñoz; Juan José Gómez-Doblas Journal: PLoS One Date: 2020-06-01 Impact factor: 3.240