ANTICOAGULANT THERAPY IN CONGESTIVE HEART FAILURE: ARE THE ADHERENCE RULES BEING FOLLOWED?
Keywords:
oral anticoacoagulation, thromboembolism, atrial fibrillation, heart failure, congestiveAbstract
Objective
Oral anticoagulation in congestive heart failure has an established consensus in some comorbidities with high thromboembolic risk (atrial fibrillation, thromboembolism, deep vein thrombosis, etc.). The objective of this study was to evaluate the indications, criteria and adherence to treatment in patients with atrial fibrillation associated with congestive heart failure.
Methods
We retrospectively analyzed 152 medical records of patients with congestive heart failure, 74 of them (48.7%) with indications for oral anticoagulation (chronic atrial fibrillation, previous thromboembolism, valvular heart disease).
Results
Of the 74 patients who were indicated for oral anticoagulation, 28 (38%) were being anticoagulated, 23 (31.1%) in an uncontrolled manner. Age over 80 years, major bleeding during anticoagulant use and low socio-economic-cultural status were the main reasons for non-anticoagulation.
Conclusion
Oral anticoagulation in patients with criteria for its application was low. The authors emphasize the importance of following established guidelines and guidance from the medical team for the adequate prevention of thromboembolic phenomena in a high-risk population.
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References
Bungard TJ, Ghali WA, Teo KK, McAlister FA, Tsuyuki RT . Why do patients with atrial fibrillation do not receive warfarin? Arch lntern Med 2000; 160:41-46.
Kannel WB, Abbott RD, Savage DD, McNamara PM. Epidemiologic features of chronic atrial fibrillation: The Framinghan Study. N Eng! J Med 1982; 306:1018-22.
Aronow WS. Correlation of arrythmias and conduction defects on the resting eletrocardiogram with new cardiac events in 1153 elderly patients. AM J Noninvas Cardiol 1991; 5:88-90.
Sherman DG, Goldman L, Whiting RB, et ai. Thromboembolism in patients with atrial fibrillation. Arch Neuro! 1984; 41:708-10.
Wolf PA, Abbott RD, Kannel WB. Atrial Fibrillation as an independent risk factor for stroke: The Framinghan Study. Stroke 1991; 22:983-88.
Tresch D, Aronow W Cardiovascular disease in the elderly patient. New York: 2nd. Marcel Dekker; 1999.
Hylek EM, Skates SJ, Sheehan MA, Singer DE. An Analysis of the Lowest Effective lntensity of Prophylactic Anticoagulation for patients with nonrheumatic atrial fibrillation. N Engl J Med 1996; 335: 540-46.
Gottlieb LK, Salem-Schatz S. Anticoagulation in atrial fibrillation: does efficacy in clinicais triais translate into effectiveness in practice? Arch lntern Med 1994; 1 54: 1945-53.
Beyth RJ, Antani MR, Covinsky KE, et ai. Why isn't warfarin prescribed to patients with nonrheumatic atrial fibrillation? J Gen lntern Med 1996; 11 :721-28.
Brass LM, Krurnholz HM, Scinto JM, Radford M. Warfarin use among patients with atrial fibrillation. Stroke 1997; 28:2382-89.
Kutner M, Nixon G, Silverstone F. Physicians' attitudes toward oral anticoagulants and antiplatelet agents for stroke prevention in elderly patients with atrial fibrillation. Arch intern Med 1991; 151:1950-53.
Lawson F, McAlister F, Ackman M, lkuta R, Montague T The utilization of antithrombotic prophylaxis for atrial fibrillation. J AM Geriatr Soe 1996; 44: 1-4.
McCrory DC, Matchar DB, Samsa G, San ders LL, Pritchett ELC. Physician attitudes about anticoagulation for nonvalvular atrial fibrillation in the elderly. Arch lnt Med 1995; 155:277-81.
Munschauer FE, Priori RL, Hens M, Castilone A. Thromboembolism prophylaxis in chronic atrial fibrillation: practice patterns in community and tertiary - care hospitais. Stroke 1997; 28:72-6.
Whittle J, Wickenheiser L, Venditti LN. Is warfarin underused in the treatment of elderly persons with atrial fibrillation? Arch lnt Med 1997; 157:441-45.
Brodsky MA, Chun JG, Podrid PJ, Douban S, Allen BJ, Cygan R. Regional attitudes of generalists, specialists, and subspecialists about management of atrial fibrillation. Arch lnt Med 1996; 156: 2553-62.
Howard PA, Duncan PW. Primary stroke prevention in non valvular atrial fibrillation: implementing the clinicai triai findings. Ann Pharmacother 1997; 31: 1187-96.
Chang HG, Bel! JR, Devoo DB, Kirk JW, Wasson JH. Physician variation in anticoagulating patients with atrial fibrillation. Arch lnt Med 1990; 150:81-4.
Lip GYH, Zarifis J, Watson RDS, Beevers DG. Physician variation in the management of patients with atrial fibrillation. Heart 1996; 75:200-5.
Thomson R, McElroy H, Sudlow M. Guidelines on anticoagulant treatment in atrial fibrillation in Great Britain: variation in content and implications for treatment BMJ 1998; 316:509-13.
Rodgers H, Sudlow M, Dobson R, Kenny RA, Thomson RG. Warfarin anticoagulation in primary care: a regional survey of present practice and clinicians' views. Br J Gen Pract 1997; 4 7:309-10.
