Mogashoa Vanessa, Mpanya Dineo, Tsabedze Nqoba
Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 17 Jubilee Road, Johannesburg, 2193, Gauteng Province, South Africa.
Thromb J. 2024 Oct 29;22(1):94. doi: 10.1186/s12959-024-00663-y.
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.
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.
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 CHADS-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.
In our study, a TTR ≥ 70%, suggesting optimal anticoagulation control, was found in only 35.6% of patients with NVAF on warfarin.
心房颤动在非洲呈日益流行之势。抗凝治疗被视为非瓣膜性心房颤动（NVAF）管理的核心，但在大多数低收入和中等收入国家（LMIC），抗凝治疗仅限于以华法林作为主要可用的抗凝疗法。服用华法林期间处于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2015年1月1日至2019年12月31日期间在南非约翰内斯堡一家三级学术中心心脏病科接受管理的NVAF患者进行了一项横断面回顾性研究。通过使用罗森达尔法计算TTR来评估NVAF患者的抗凝控制情况。
研究人群包括177例被诊断为NVAF的患者。平均年龄为65.0±13.1岁。NVAF患者的TTR中位数为46%[四分位间距（IQR）：8.7 - 86.0]，63例（35.6%）NVAF患者的TTR≥70%（最佳抗凝控制）。与抗凝控制最佳的患者相比，抗凝控制不佳（TTR<70%）的患者服用华法林的时间较短[56天（IQR：43 - 84）对70天（IQR：56 - 140），p = 0.0013]。平均CHADS - VASc评分为4±1.5，抗凝控制不佳或最佳的患者之间无差异。在175例有可用HAS - BLED评分的患者中，分别有21例（12.0%）、112例（64.0%）和42例（24.0%）处于低、中、高出血风险。在HAS - BLED低风险类别的21例患者中，只有4例（19.0%）的TTR<70%（p<0.001）。有13例（7.3%）患者记录有华法林毒性。
在我们的研究中，在接受华法林治疗的NVAF患者中，只有35.6%的患者TTR≥70%，提示抗凝控制最佳。
