Restraints to Anticoagulation Prescription in Atrial Fibrillation and Attitude Towards the New Oral Anticoagulants
Autor(a) principal: | |
---|---|
Data de Publicação: | 2013 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4105 |
Resumo: | Introduction and Objectives: To evaluate the prescription rate of oral anticoagulants in atrial fibrillation, the factors associated with non-prescription, the reasons referred by the physicians for not prescribing anticoagulants including the new generation anticoagulants, and to perform a medium term follow-up assessment. Materials and Methods: Prospective study on consecutive patients with atrial fibrillation with hospital discharge. The CHA2DS2VASc and HASBLED scores, associated comorbidities and medication prescribed before and at discharge were assessed. At discharge, the reason for not prescribing oral anticoagulants and the new oral anticoagulants was indicated by the physician in a questionnaire. Exclusion: absolute contraindication for anticoagulation, CHA2DS2VASc ≤ 1 and valvular disease. Follow-up data were obtained one year after the recruitment of the first patient. Results: 103 candidates for oral anticoagulants were identified (79.6 ± 8.0 years; CHA2DS2VASc 5.8 ± 1.4; HASBLED 2.6 ± 1.0; HASBLED ≥ 3 in 55.3%); the anticoagulants were prescribed in 34.0% of the candidates. The factors associated with non-prescription were, in decreasing order of relevance: previous use of antiplatelet agents, bedridden and/or demented patient, absence of heart failure and number of bleeding risk factors. The reasons referred by physicians for non-prescription were, in decreasing order of frequency: high bleeding risk, small benefit, inability to comply with the treatment regimen and difficulty in monitoring the international normalized ratio (INR). The new anticoagulants were not prescribed and the referred reasons were, in decreasing order of frequency: insufficient information on the drugs, high bleeding risk, high cost and small benefit. At 8.2 ± 2.5 months of follow-up 33.3% of the patients were on anticoagulation and the new anticoagulants had not been prescribed. Conclusions: In this sample, the anticoagulants prescription rate was low and the factor most associated with non-prescription was the previous use of antiplatelet agents. Bleeding risk was the most referred barrier for prescription, followed by a small recognized benefit. The main referred barriers for new anticoagulants prescription were insufficient information and high bleeding risk. At medium-term follow-up the proportion of patients under anticoagulation was still low and the new anticoagulants had not been prescribed. |
id |
RCAP_240a1db9c7c9c0d561b01cddc8ee1039 |
---|---|
oai_identifier_str |
oai:ojs.www.actamedicaportuguesa.com:article/4105 |
network_acronym_str |
RCAP |
network_name_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository_id_str |
7160 |
spelling |
Restraints to Anticoagulation Prescription in Atrial Fibrillation and Attitude Towards the New Oral AnticoagulantsImpedimentos à Prescrição de Anticoagulação na Fibrilhação Auricular e Atitude Face aos Novos Anticoagulantes OraisIntroduction and Objectives: To evaluate the prescription rate of oral anticoagulants in atrial fibrillation, the factors associated with non-prescription, the reasons referred by the physicians for not prescribing anticoagulants including the new generation anticoagulants, and to perform a medium term follow-up assessment. Materials and Methods: Prospective study on consecutive patients with atrial fibrillation with hospital discharge. The CHA2DS2VASc and HASBLED scores, associated comorbidities and medication prescribed before and at discharge were assessed. At discharge, the reason for not prescribing oral anticoagulants and the new oral anticoagulants was indicated by the physician in a questionnaire. Exclusion: absolute contraindication for anticoagulation, CHA2DS2VASc ≤ 1 and valvular disease. Follow-up data were obtained one year after the recruitment of the first patient. Results: 103 candidates for oral anticoagulants were identified (79.6 ± 8.0 years; CHA2DS2VASc 5.8 ± 1.4; HASBLED 2.6 ± 1.0; HASBLED ≥ 3 in 55.3%); the anticoagulants were prescribed in 34.0% of the candidates. The factors associated with non-prescription were, in decreasing order of relevance: previous use of antiplatelet agents, bedridden and/or demented patient, absence of heart failure and number of bleeding risk factors. The reasons referred by physicians for non-prescription were, in decreasing order of frequency: high bleeding risk, small benefit, inability to comply with the treatment regimen and difficulty in monitoring the international normalized ratio (INR). The new anticoagulants were not prescribed and the referred reasons were, in decreasing order of frequency: insufficient information on the drugs, high bleeding risk, high cost and small benefit. At 8.2 ± 2.5 months of follow-up 33.3% of the patients were on anticoagulation and the new anticoagulants had not been prescribed. Conclusions: In this sample, the anticoagulants prescription rate was low and the factor most associated with non-prescription was the previous use of antiplatelet agents. Bleeding risk was the most referred barrier for prescription, followed by a small recognized benefit. The main referred barriers for new anticoagulants prescription were insufficient information and high bleeding risk. At medium-term follow-up the proportion of patients under anticoagulation was still low and the new anticoagulants had not been prescribed.Introdução e Objetivos: Avaliar a taxa de prescrição de anticoagulantes orais na fibrilhação auricular, os fatores associados à não prescrição, os motivos referidos pelos clínicos para não prescrição de anticoagulantes incluindo os de nova geração e realizar estudo evolutivo a médio prazo. Material e Métodos: Estudo prospetivo sobre casos consecutivos de doentes com fibrilhação auricular com alta hospitalar. Registaram- se os scores CHA2DS2VASc e HASBLED, comorbilidades associadas e a medicação prévia e à data de alta. Na alta hospitalar, o médico assistente indicou em questionário o motivo de não prescrição de anticoagulantes orais e dos novos anticoagulantes orais. Exclusão: contra-indicação absoluta para anticoagulação, CHA2DS2VASc ≤ 1 e doença valvular. Os doentes foram reavaliados um ano após o recrutamento do primeiro doente. Resultados: Identificaram-se 103 candidatos a anticoagulação oral (79,6 ± 8,0 anos; CHA2DS2VASc 5,8 ± 1,4; HASBLED 2,6 ± 1,0; HASBLED ≥ 3 em 55,3%); os anticoagulantes foram prescritos em 34,0%. Fatores associados à não prescrição por ordem decrescente de relevância: uso prévio de antiagregantes, doente acamado e/ou demente, ausência de insuficiência cardíaca e número de fatores de risco hemorrágico. Razões invocadas para não prescrição por ordem decrescente de frequência: risco hemorrágico elevado, pequeno benefício, incapacidade de seguir o esquema terapêutico e dificuldade na monitorização da razão normalizada internacional (INR). Os novos anticoagulantes não foram prescritos e as razões invocadas foram, por ordem decrescente de frequência: informação insuficiente sobre estes fármacos, risco hemorrágico elevado, custo elevado e pequeno benefício. Aos 8,2 ± 2,5 meses de estudo evolutivo 33,3% dos doentes encontravam-se sob anticoagulação sem que os novos anticoagulantes tivessem sido prescritos. Conclusões: Nesta amostra, a taxa de prescrição de anticoagulação oral foi baixa e o fator mais associado à não prescrição foi o uso prévio de antiagregantes. O impedimento à prescrição mais referido foi o risco hemorrágico, seguido do pequeno benefício reconhecido. Os principais impedimentos referidos à prescrição dos novos anticoagulantes foram a informação insuficiente e o alto risco hemorrágico. A médio prazo, a proporção de doentes sob anticoagulação mantinha-se baixa e os novos anticoagulantes não tinham sido prescritos.Ordem dos Médicos2013-05-31info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4105oai:ojs.www.actamedicaportuguesa.com:article/4105Acta Médica Portuguesa; Vol. 26 No. 2 (2013): March-April; 127-132Acta Médica Portuguesa; Vol. 26 N.º 2 (2013): Março-Abril; 127-1321646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4105https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4105/3237Pereira-Da-Silva, TiagoSouto Moura, TeresaAzevedo, LuísaSá Pereira, MargaridaVirella, DanielAlves, MartaBorges, Luísinfo:eu-repo/semantics/openAccess2022-12-20T11:03:16Zoai:ojs.www.actamedicaportuguesa.com:article/4105Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:18:41.852423Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Restraints to Anticoagulation Prescription in Atrial Fibrillation and Attitude Towards the New Oral Anticoagulants Impedimentos à Prescrição de Anticoagulação na Fibrilhação Auricular e Atitude Face aos Novos Anticoagulantes Orais |
title |
Restraints to Anticoagulation Prescription in Atrial Fibrillation and Attitude Towards the New Oral Anticoagulants |
spellingShingle |
Restraints to Anticoagulation Prescription in Atrial Fibrillation and Attitude Towards the New Oral Anticoagulants Pereira-Da-Silva, Tiago |
title_short |
Restraints to Anticoagulation Prescription in Atrial Fibrillation and Attitude Towards the New Oral Anticoagulants |
title_full |
Restraints to Anticoagulation Prescription in Atrial Fibrillation and Attitude Towards the New Oral Anticoagulants |
title_fullStr |
Restraints to Anticoagulation Prescription in Atrial Fibrillation and Attitude Towards the New Oral Anticoagulants |
title_full_unstemmed |
Restraints to Anticoagulation Prescription in Atrial Fibrillation and Attitude Towards the New Oral Anticoagulants |
title_sort |
Restraints to Anticoagulation Prescription in Atrial Fibrillation and Attitude Towards the New Oral Anticoagulants |
author |
Pereira-Da-Silva, Tiago |
author_facet |
Pereira-Da-Silva, Tiago Souto Moura, Teresa Azevedo, Luísa Sá Pereira, Margarida Virella, Daniel Alves, Marta Borges, Luís |
author_role |
author |
author2 |
Souto Moura, Teresa Azevedo, Luísa Sá Pereira, Margarida Virella, Daniel Alves, Marta Borges, Luís |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
Pereira-Da-Silva, Tiago Souto Moura, Teresa Azevedo, Luísa Sá Pereira, Margarida Virella, Daniel Alves, Marta Borges, Luís |
description |
Introduction and Objectives: To evaluate the prescription rate of oral anticoagulants in atrial fibrillation, the factors associated with non-prescription, the reasons referred by the physicians for not prescribing anticoagulants including the new generation anticoagulants, and to perform a medium term follow-up assessment. Materials and Methods: Prospective study on consecutive patients with atrial fibrillation with hospital discharge. The CHA2DS2VASc and HASBLED scores, associated comorbidities and medication prescribed before and at discharge were assessed. At discharge, the reason for not prescribing oral anticoagulants and the new oral anticoagulants was indicated by the physician in a questionnaire. Exclusion: absolute contraindication for anticoagulation, CHA2DS2VASc ≤ 1 and valvular disease. Follow-up data were obtained one year after the recruitment of the first patient. Results: 103 candidates for oral anticoagulants were identified (79.6 ± 8.0 years; CHA2DS2VASc 5.8 ± 1.4; HASBLED 2.6 ± 1.0; HASBLED ≥ 3 in 55.3%); the anticoagulants were prescribed in 34.0% of the candidates. The factors associated with non-prescription were, in decreasing order of relevance: previous use of antiplatelet agents, bedridden and/or demented patient, absence of heart failure and number of bleeding risk factors. The reasons referred by physicians for non-prescription were, in decreasing order of frequency: high bleeding risk, small benefit, inability to comply with the treatment regimen and difficulty in monitoring the international normalized ratio (INR). The new anticoagulants were not prescribed and the referred reasons were, in decreasing order of frequency: insufficient information on the drugs, high bleeding risk, high cost and small benefit. At 8.2 ± 2.5 months of follow-up 33.3% of the patients were on anticoagulation and the new anticoagulants had not been prescribed. Conclusions: In this sample, the anticoagulants prescription rate was low and the factor most associated with non-prescription was the previous use of antiplatelet agents. Bleeding risk was the most referred barrier for prescription, followed by a small recognized benefit. The main referred barriers for new anticoagulants prescription were insufficient information and high bleeding risk. At medium-term follow-up the proportion of patients under anticoagulation was still low and the new anticoagulants had not been prescribed. |
publishDate |
2013 |
dc.date.none.fl_str_mv |
2013-05-31 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4105 oai:ojs.www.actamedicaportuguesa.com:article/4105 |
url |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4105 |
identifier_str_mv |
oai:ojs.www.actamedicaportuguesa.com:article/4105 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4105 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/4105/3237 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Ordem dos Médicos |
publisher.none.fl_str_mv |
Ordem dos Médicos |
dc.source.none.fl_str_mv |
Acta Médica Portuguesa; Vol. 26 No. 2 (2013): March-April; 127-132 Acta Médica Portuguesa; Vol. 26 N.º 2 (2013): Março-Abril; 127-132 1646-0758 0870-399X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
repository.mail.fl_str_mv |
|
_version_ |
1799130638442299392 |