Warfarin treatment was associated with a non-significant 1.3-fold increase in non-fatal bleeding compared to NOACs (OR 1.3; 95% CI 0.2-9.2; p=0.8) in patients with CHF and AF.
Observational (n=272)
Does the choice of anticoagulant therapy affect bleeding risk and therapeutic efficacy in real-world patients with CHF and AF?
In real-world patients with CHF and AF, maintaining adequate TTR on warfarin is challenging, supporting the preferential use of NOACs.
Effect estimate: OR 1.3 (95% CI 0.2-9.2)
p-value: p=0.8
Background. Prevalence of atrial fibrillation (AF) grows with the increase in CHF FC and reaches 45% in III-IV FC CHF. With an adequate anticoagulant (AC) therapy, the risk of thromboembolic complications does not significantly differ between patients with I-II FC and III-IV FC CHF. Of particular interest is studying administration of the anticoagulant treatment and correspondence between the SAMe-TT 2 R 2 scale and actual TTR values in patients with CHF and AF in real-life clinical practice. Aim. Toanalyze the efficacy of anticoagulant therapy and prognosis in patients with CHF and AF in the setting of real-life clinical practice. Materials and methods. The study included 272 patients with CHF and AF who were discharged from the hospital where they had been treated for decompensated CHF and who were followed up as outpatients for a year. Efficacy of the AC therapy was evaluated; parameters of CHA 2 DS 2 -VASc, HAS-BLED, and SAMe-TT 2 R2 scales were calculated at baseline. TTR was computed to determine the mainte nance time. Results. Patients with CHF had permanent (56.3%), persistent (38.6%), or paroxysmal (5.1%) AF. The mean CHA 2 DS 2 -VASc score was 3.83±1.16 and the mean HAS-BLED score was 1.3±0.83. SAMe-TT 2 R 2 scores were 0 for 1.6% of patients; 1 for 36.9%, and 2 70% was observed for 12.6% patients receiving warfarin. One female patient from the NOAC group had fatal GI bleeding. Non-fatal bleeding was observed 1.3 times more frequently during the warfarin treatment (OR=1.3; 0.2-9.2; р=0.8). Conclusion. Most patients with CHF and AF had high CHA 2 DS 2 -VASc values and low HAS-BLED values. In real-life outpatient practice, there is a gap between clinical recommendations and reality. Maintaining sufficient TTR values in patients with CHF and AF receiving warfarin is not always possible, which supports the priority of NOAC treatment.
Виноградова et al. (Sun,) conducted a observational in Congestive Heart Failure and Atrial Fibrillation (n=272). Warfarin vs. NOAC was evaluated on Non-fatal bleeding (OR 1.3, 95% CI 0.2-9.2, p=0.8). Warfarin treatment was associated with a non-significant 1.3-fold increase in non-fatal bleeding compared to NOACs (OR 1.3; 95% CI 0.2-9.2; p=0.8) in patients with CHF and AF.