ANTICOAGULATION IN ATRIAL FIBRILLATION PATIENTS AFTER CARDIOEMBOLIC STROKE: EVALUATION OF TREATMENT ADHERENCE IN REAL PRACTICE (Cohort study “APOLLON”)
https://doi.org/10.15829/1560-4071-2017-7-105-110
Abstract
Aim. To study the adherence to anticoagulation therapy of AF patients after CES, in real clinical practice.
Material and methods. From 01.10.2013 to 31.03.2015 the data was analyzed, of 1291 patients after CES, and of those 661 fulfilled the inclusion/exclusion criteria (36,9% of males and 63,1% of females, mean age 68 y.o.). During the 12-month period of follow-up, 2 phone calls performed, in 180±5 days (V1) and 360±5 days (V2) from the stroke onset.
Results. In 2014 only 6,9% of participants were taking anticoagulants, in 2015 — 17,5%. Only a half (n=330) of those knew of AF they had; 26,2% regarded AF as a risk factor life threatening and related to recurrent stroke; 15,4% refused to follow clinician prescriptions on anticoagulation. As the main medication, 65,3% patients noted acetylsalicylic acid, and only 7,9% — various anticoagulants. Annual mortality was 16,0%.
Conclusion. In real clinical practice, AF patients after stroke have the same low awareness on anticoagulation necessity, as adherence, regardless of high annual mortality
About the Authors
I. A. Zolotovskaya
Samara State Medical University of the Ministry of Health;
Samara Oblast City Polyclinics №9
Russian Federation
Russian Federation
I. L. Davydkin
Samara State Medical University of the Ministry of Health
Russian Federation
Russian Federation
D. V. Duplyakov
Samara State Medical University of the Ministry of Health;
Samara Oblast Clinical Dispensary of Cardiology
Russian Federation
Russian Federation
References
1. Camm JA, Singer DE. Device-detected atrial fibrillation and risk for stroke: an analysis of >10,000 patients from the SOS AF project (Stroke preventiOn Strategies based on Atrial Fibrillation information from implanted devices). Eur Heart J 2014; 35(8): 508-16.
2. Freedman B, Potpara TS, Lip GY. Stroke prevention in atrial fibrillation. Lancet. 2016; 20; 388 (10046): 806-17.
3. Ahmad Y, Lip GY, Lane DA. Recent developments in understanding epidemiology and risk determinants of atrial fibrillationas a cause of stroke. Can J Cardiol 2013; 29 (7 Suppl): 4-13.
4. Projections of mortality and causes of death, 2015 and 2030. Available at: www.who.int/healthinfo/global_burden_disease/en/
5. Starodubov VI, Shchepin OP. Public health and health care. National guideline. M.: GEOTAR-Media, 2013. 624. Russian (Стародубов В.И., Щепин О.П. Общественное здоровье и здравоохранение. Национальное руководство М.: ГЭОТАР-Медиа, 2013. 624).
6. Sanchez-Larsen A, García-Garcia J, Ayo-Martin O, et al. Has the aetiology of ischaemic stroke changed in the past decades? Analysis and comparison of data from current and historical stroke databases. Neurologia 2016 Sep 16. pii: S0213-4853(16)30168-2. doi: 10.1016/j.nrl.2016.07.003.
7. Patel MR, Mahaffey KW, Garg J, et al. ROCKET AF Investigators. Collaborators (1236). Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. N Engl. J Med 2011; 365: 883-91.
8. Granger CB, Alexander JH, McMurray JJ. for the ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011; 365: 981-92.
9. Ezekowitz MD, Connolly S, Parekh A. Rationale and design of RE-LY®: Randomized evaluation of long-term anticoagulant therapy, warfarin, compared with dabigatran. Am Heart J 2009; 157(5): 805-10.
10. National Heart, Lung, and Blood Institute. Types of Strokes. Available at: www.nhlbi.nih.gov/health/health-topics/topics/stroke/types.html. Accessed 21 November 2013.
11. Steger C, Pratter A, Martinek-Bregel M, et al. Stroke patients with atrial fibrillation have a worse prognosis than patients without: data from the Austrian Stroke Registry. Eur Heart J 2004; 25: 1734-40.
12. Saxena R, Lewis S, Berge E, et al. Risk of early death and recurrent stroke and effect of heparin in 3169 patients with acute ischemic stroke and atrial fibrillation in the international stroke trial. Stroke 2001; 32: 2333-7.
13. Olavarria VV, Delgado I, Hoppe A, et al. Validity of the NIHSS in predicting arterial occlusion in cerebral infarction is time-dependent. Neurology 2011; 76: 62-8.
14. Maas MB, Furie KL, Lev MH, et al. National Institutes of Health Stroke Scale score is poorly predictive of proximal occlusion in acute cerebral ischemia. Stroke 2009; 40: 2988-93.
15. Pisters R, Lane DA, Nieuwlaat R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: The Euro Heart Survey. Chest 2010; 138 (5): 1093.
16. Boriani G, Diemberger I, Biffi M, et al. Balancing the risk of hemorrhage vs thromboembolism in patients with atrial fibrillation: how to navigate between Scylla and Charybdis? Chest 2010; 138 (5): 1032-3. doi: 10.1378/chest.10-0808.
17. Camm J, Lip GY, De Caterina R. 2012 focused update of the ECS Guidelines for the management of atrial fibrillation. An update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of European Heart Rhythm Association. Eur Heart J 2012; 33: 2719-47.
18. Lip GY, Frison L, Halperin JL, et al. Comparative validation of a novel risk score for predicting bleeding risk in anticoagulated patients with atrial fibrillation: the HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) score. J Am Coll Cardiol 2011; 57(2): 173-80.
19. He Boriani G, Glotzer TV, Santini M, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 2006; 27: 949-53.
20. Lip GY, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation. Chest 2010; 137: 263-72.
Review
For citations:
Zolotovskaya I.A., Davydkin I.L., Duplyakov D.V. ANTICOAGULATION IN ATRIAL FIBRILLATION PATIENTS AFTER CARDIOEMBOLIC STROKE: EVALUATION OF TREATMENT ADHERENCE IN REAL PRACTICE (Cohort study “APOLLON”). Russian Journal of Cardiology. 2017;(7):105-110. (In Russ.) https://doi.org/10.15829/1560-4071-2017-7-105-110
Views:
1493
Email this article 