Anticoagulation control for nonvalvular atrial fibrillation in a tertiary academic centre in Johannesburg.

IF 2.6 4区医学 Q2 HEMATOLOGY Thrombosis Journal Pub Date : 2024-10-29 DOI:10.1186/s12959-024-00663-y

Vanessa Mogashoa, Dineo Mpanya, Nqoba Tsabedze

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引用次数: 0

Abstract

Background: Atrial fibrillation is a growing epidemic in Africa. Anticoagulation, considered the backbone for non-valvular atrial fibrillation (NVAF) management, is limited to warfarin as the mainstay of available anticoagulation therapy in most low- and middle-income countries (LMIC). The optimal time in the therapeutic range (TTR) while on warfarin is essential to avoid bleeding and thromboembolic complications. This study assessed anticoagulation control in patients with NVAF on warfarin in Johannesburg, South Africa.

Methods: We conducted a cross-sectional retrospective study on patients with NVAF managed in the Division of Cardiology, at a tertiary-level academic centre in Johannesburg, South Africa, between 1 January 2015 and 31 December 2019. Anticoagulation control for patients with NVAF was assessed by calculating the TTR using the Rosendaal method.

Results: The study population comprised 177 patients diagnosed with NVAF. The mean age was 65.0 ± 13.1 years. The median TTR among patients with NVAF was 46% [interquartile range (IQR): 8.7-86.0], and 63 (35.6%) patients with NVAF had a TTR ≥ 70% (optimal anticoagulation control). Patients with poor anticoagulation control (TTR < 70%) were on warfarin for a shorter duration compared with those with optimal anticoagulation control [56 days (IQR: 43-84) vs. 70 days (IQR: 56-140), p = 0.0013]. The mean CHA₂DS₂-VASc score was 4 ± 1.5, and it did not differ between patients with poor or optimal anticoagulation control. Among the 175 patients with available HAS-BLED scores, 21 (12.0%), 112 (64.0%) and 42 (24.0%) were at a low, moderate, and high risk for bleeding, respectively. Of the 21 patients in the HAS BLED low-risk category, only 4 (19.0%) had a TTR < 70% (p < 0.001). Warfarin toxicity was documented in 13 (7.3%) patients.

Conclusion: In our study, a TTR ≥ 70%, suggesting optimal anticoagulation control, was found in only 35.6% of patients with NVAF on warfarin.

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约翰内斯堡一家三级学术中心对非瓣膜性心房颤动的抗凝控制。

背景：心房颤动在非洲日益流行。抗凝治疗被认为是非瓣膜性心房颤动（NVAF）治疗的支柱，但在大多数中低收入国家（LMIC），抗凝治疗的主要手段仅限于华法林。服用华法林期间在治疗范围内的最佳时间（TTR）对于避免出血和血栓栓塞并发症至关重要。本研究评估了南非约翰内斯堡接受华法林治疗的 NVAF 患者的抗凝控制情况：我们对南非约翰内斯堡一家三级学术中心心脏病科在 2015 年 1 月 1 日至 2019 年 12 月 31 日期间收治的 NVAF 患者进行了横断面回顾性研究。采用罗森达尔法计算TTR，评估NVAF患者的抗凝控制情况：研究对象包括 177 名确诊为 NVAF 的患者。平均年龄为 65.0 ± 13.1 岁。NVAF 患者的 TTR 中位数为 46%[四分位距（IQR）：8.7-86.0]，63 名（35.6%）NVAF 患者的 TTR ≥ 70%（最佳抗凝控制）。抗凝控制不佳的患者（TTR 2DS2-VASc 评分为 4 ± 1.5，抗凝控制不佳或最佳的患者之间没有差异。在有 HAS-BLED 评分的 175 名患者中，分别有 21 人（12.0%）、112 人（64.0%）和 42 人（24.0%）处于出血的低危、中危和高危状态。在 HAS BLED 低风险类别的 21 名患者中，只有 4 人（19.0%）有 TTR 结论：在我们的研究中，只有 35.6% 服用华法林的 NVAF 患者的 TTR ≥ 70%，这表明抗凝控制达到了最佳水平。

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来源期刊

Thrombosis Journal Medicine-Hematology

CiteScore

3.80

自引率

3.20%

发文量

审稿时长

16 weeks

期刊介绍： Thrombosis Journal is an open-access journal that publishes original articles on aspects of clinical and basic research, new methodology, case reports and reviews in the areas of thrombosis. Topics of particular interest include the diagnosis of arterial and venous thrombosis, new antithrombotic treatments, new developments in the understanding, diagnosis and treatments of atherosclerotic vessel disease, relations between haemostasis and vascular disease, hypertension, diabetes, immunology and obesity.