Epidemiology, anticoagulant treatment and risk of thromboembolism in patients with valvular atrial fibrillation: Results from Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER)

Kaya, Hasan; Ertaş, Faruk; Kaya, Zekeriya; Eren, Nihan Kahya; Yüksel, Murat; Köroğlu, Bayram; Köse, Nuri; Yıldız, Abdülkadir; Çi̇men, Tolga; Ülgen, Mehmet Sıddık

doi:10.5603/cj.a2013.0085

Cited by 7 publications

(12 citation statements)

References 21 publications

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“…On one hand, a considerable proportion of patients with embolic risk factors do not receive OAC therapy (13, 19), and on the other side, there is the problem of inappropriate combination of aspirin with warfarin, which ranges from 15% to 40% in the published literature (2,3,13,15-17), whereas it was 21.1% in our study. Perhaps more importantly, this practice occurs in patients with AF in the absence of firm evidence for clinical benefit.…”

Section: Discussioncontrasting

confidence: 61%

“…The proportion of patients with MHV was high in our work probably because of a higher prevalence of rheumatic heart disease in our country compared with the western world (13). Recent Atrial Fibrillation in Turkey: Epidemiologic Registry reported 37% effective INR in patients with nonvalvular AF (14) and 36.1% effective INR in those with valvular AF, including MHV (15). In the present study, we found that 43.6% of all patients (43.2% in AF, 44.2% in MHV) had INR within the therapeutic range, which is slightly better.…”

Section: Discussionmentioning

confidence: 99%

“…Observational studies and randomized trials have demonstrated high rates of bleeding with the combination of aspirin and OAC (2,3,15). A meta-analysis of randomized controlled trials (1) comparing two treatment strategies showed that there was no difference in the risk for arterial thromboembolism with combination treatment in patients with atrial fibrillation (OR, 0.99; 95% CI, 0.47–2.07).…”

Section: Discussionmentioning

confidence: 99%

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Inappropriate combination of warfarin and aspirin

Turan¹,

Demır

Daşlı³

et al. 2015

Anatol J Cardiol

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Objective:A combination of warfarin and aspirin is associated with increased bleeding compared with warfarin monotherapy. The aim of the study was to investigate the incidence and appropriateness of the combination of warfarin and aspirin in patients with atrial fibrillation (AF) or mechanical heart valve (MHV).Methods:This cross-sectional study included consecutive patients with AF or MHV on chronic warfarin therapy (>3 months) without acute coronary syndrome or have not undergone a revascularization procedure in the preceding year. Medical history, concomitant diseases, and treatment data were acquired through patient interviews and from hospital records.Results:Three hundred and sixty patients (213 with AF, 147 with MHV) were included. In those with AF, a significantly higher warfarin-aspirin combination was observed with concomitant vascular disease (38.8% vs. 14.6%), diabetes (36.6% vs. 16.3%), statin therapy (40% vs. 16.9%), left ventricular systolic dysfunction (33.3% vs. 17.5%) (p<0.05 for all). The use of combination therapy was similar between different CHADS-VASc scores. In patients with MHV, higher combination therapy was observed in males (41% vs. 26.7% in females; p=0.070), concomitant vascular disease (47.8% vs. 29.8%; p=0.091), and AF (56.3% vs. 29.8%; p=0.033). Independent predictors of warfarin-aspirin combination were concomitant vascular disease, diabetes, and (younger) age in patients with AF and were concomitant AF and male sex in patients with MHV. Interestingly, the incidence of combination therapy was found to increase with a higher HAS-BLED score in both patients with AF and MHV (p<0.001).Conclusion:The combination of warfarin and aspirin was found to be prescribed to patients with AF mainly for the prevention of cardiovascular events, for which warfarin monotherapy usually suffices. On the other hand, co-treatment with aspirin appeared to be underused in patients with MHV. (Anatol J Cardiol 2016; 16: 189-96)

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Inappropriate combination of warfarin and aspirin

Turan¹,

Demır

Daşlı³

et al. 2015

Anatol J Cardiol

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“…Indications and the prevalence of digoxin use are not well studied among Turkish patients with AF. The only Turkish multicentre study available including patients with AF was the AFTER study, which had shown that 27·7% of the patients were on digoxin therapy . However, the indications and appropriateness of digoxin use was not evaluated in the AFTER study.…”

Section: Introductionmentioning

confidence: 99%

“…The only Turkish multicentre study available including patients with AF was the AFTER study, which had shown that 27Á7% of the patients were on digoxin therapy. 11 However, the indications and appropriateness of digoxin use was not evaluated in the AFTER study. Therefore, we sought to investigate the prevalence, indications and appropriateness of digoxin prescription in a large, real-world population of Turkish patients with non-valvular AF (NVAF).…”

Section: Introductionmentioning

confidence: 99%