Pereira-Da-Silva Tiago, Souto Moura Teresa, Azevedo Luísa, Sá Pereira Margarida, Virella Daniel, Alves Marta, Borges Luís
Serviço de Cardiologia, Hospital de Santa Marta (CHLC), Lisboa, Portugal.
Acta Med Port. 2013 Mar-Apr;26(2):127-32. Epub 2013 May 31.
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.
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.
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.
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.
评估心房颤动患者口服抗凝药的处方率、与未处方相关的因素、医生提及的未开具抗凝药（包括新一代抗凝药）的原因，并进行中期随访评估。
对连续出院的心房颤动患者进行前瞻性研究。评估CHA2DS2VASc和HASBLED评分、相关合并症以及出院前和出院时开具的药物。出院时，医生通过问卷指出未开具口服抗凝药和新型口服抗凝药的原因。排除标准：抗凝治疗的绝对禁忌症、CHA2DS2VASc = 1以及瓣膜病。在招募首位患者一年后获取随访数据。
确定了103名口服抗凝药候选患者（年龄79.6 ± 8.0岁；CHA2DS2VASc 5.8 ± 1.4；HASBLED 2.6 ± 1.0；55.3%的患者HASBLED = 3）；34.0%的候选患者开具了抗凝药。与未处方相关的因素，按相关性从高到低依次为：既往使用抗血小板药物、卧床和/或痴呆患者、无心力衰竭以及出血风险因素数量。医生提及的未处方原因，按频率从高到低依次为：出血风险高、获益小、无法遵守治疗方案以及国际标准化比值（INR）监测困难。未开具新型抗凝药，提及的原因按频率从高到低依次为：药物信息不足、出血风险高、成本高以及获益小。在8.2 ± 2.5个月的随访中，33.3%的患者接受抗凝治疗，且未开具新型抗凝药。
在本样本中，抗凝药处方率较低，与未处方最相关的因素是既往使用抗血小板药物。出血风险是提及最多的处方障碍，其次是公认的获益小。新型抗凝药处方的主要提及障碍是信息不足和出血风险高。在中期随访中，接受抗凝治疗的患者比例仍然较低，且未开具新型抗凝药。
