Key result
In a one-year follow-up of patients with atrial fibrillation, 56% had poor control of oral anticoagulation, which was significantly associated with hyperglycemia, diabetes mellitus, and left ventricular hypertrophy.
Observational (n=87)
No
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Poor anticoagulation control in AF was linked to diabetes and LVH; hypothesis-generating for targeted monitoring strategies.
OBJECTIVE: The aim of the study is to determine the number of patients with an optimal level of anticoagulant effect by monitoring the values of prothrombine time (PT) and International normalized ratio (INR) in the observed group of patients, and also to see which factors, co-morbidities and echocardiographic parameters are associated with the effectiveness of oral anticoagulant therapy (OAC). METHODS: This longitudinal, prospective study included 87 consecutive patients with atrial fibrillation on the OAC; 68/87 (78%) patients were treated with acenocumarol, while 19/87 (22%) were treated with warfarin. Criteria for excellent quality of anticoagulation were that during one year 5 to 7 measured values of PT / INR be ≥ 2 (analogous to TTR> 60-85% of time). Good anticoagulation is defined as 3 to 4 values of PT INR to be in the therapeutic range for one-year monitoring (analogous to Time in Therapeutic Range-TTR 50 to 60% of the time). Poor anticoagulation is defined to be 0-2 of the measured INR in the therapeutic range (analogous to TTR <50%). RESULTS: During one-year follow-up, based on the successive values of PT and INR, 87 patients with atrial fibrillation were classified into three groups: group A - excellent control of the anticoagulant effect N = 14/87 (16%), group B - good control of anticoagulation N = 24/87 (28%), group C - poor control of anticoagulant effect N = 49/87 (56%). CHA2DS2-VASc thromboembolism score was slightly higher in group C (A = 3.3, vs B = 3, 4 Vs C = 3.6) while the risk of bleeding -HAS-BLED score was statistically significantly lower in group C (B = 32% vs A 28.6% versus C22.6%. In individual distribution, all three groups were dominated by obese patients A- 57%, B-56%, C-48%) and overweight (A-35%, B-36%, C-39%) without statistically significant difference. (Xi² = 0.487). The highest level of glycaemia was in group C with poor quality of anticoagulation (C-6,5 versus A and C=5,8 mmol/L). Also, group C has statistically significant number of diabetic patients (C=31% versus A-21% vs B 12,5%). The most important echocardiographic parameter was LV myocardial mass index (LVMI). LVMI was found in group C (LVMI=134g/m2) with the highest value and statistically significantly higher than the values of the other two groups (p<0,05). CONCLUSION: Excellent quality of anticoagulant effect of chronic therapy with dicumarol preparations in order to prevent thromboembolism was in only 16% of patients and good quality was in 28% at the one-year follow-up. Unfortunately, poor control of anticoagulation in as much as 56% of patients is predominant. Hyperglycaemia and diabetes mellitus were the most important clinical factors significantly associated with poor effectiveness of oral anticoagulant therapy (OAK). Echocardiographically determined level of left ventricular hypertrophy was statistically significantly associated with poor effectiveness of oral anticoagulation. Poor patient compliance was still probably the main reason of poor quality of oral anticoagulation therapy.
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Aranđelović et al. (2017) conducted an observational in Atrial fibrillation (n=87). Oral anticoagulant therapy (acenocumarol or warfarin) was evaluated on Poor control of anticoagulant effect (0-2 INR values in therapeutic range, analogous to TTR <50%). In a one-year follow-up of patients with atrial fibrillation, 56% had poor control of oral anticoagulation, which was significantly associated with hyperglycemia, diabetes mellitus, and left ventricular hypertrophy.
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