Atrial fibrilasyonda pıhtı önleyici tedavi uygulamalarında Kılavuzlara uygunluğun araştırılması: İkincil merkez deneyimi

Amaç: Atrial fibrilasyon (AF) en sık görülen kalıcı ritim bozukluğudur. AF tanı ve tedavisi için bir çok kılavuz yayınlanmıştır. İnmenin önlenmesi için Avrupa Kardiyoloji Derneği (ESC) tarafından önerilen risk hesaplama tablosunun (CHA2DS2-VASC skoru) uygulanmasıyla ilgili veriler oldukça sınırlıdır. Amacımız AF tedavisinde kılavuzların ve CHA2DS2-VASC skorunun kardiyoloji uzmanları tarafından uygulamasına ait verileri ortaya koymaktır. Gereç ve Yöntem: Retrospektif olarak 2012 yılı içinde kardiyoloji polikliniğinde AF tanısıyla takip edilen hastalar çalışmaya alındı. Hastaların klinik ve demografik özellikleri kaydedilerek CHA2DS2-VASC skoru ve uygulanan tedaviler incelendi. Bir yıl içinde yapılan International Normalized Ratio (INR) tetkik sonuçlarına göre pıhtı önleyici tedavinin başarı durumu değerlendirildi. Bulgular: 2012 yılında kardiyoloji polikliniğine başvuran 2303 hastanın 137 (%6,2)sine AF tanısı konuldu. Çalışmaya alınan 128 hastanın 83ü (%64,8) kadındı. Yaş ortalaması 67,5±10,9 yıldı. Ortalama CHA2DS2-VASC skoru 3,36±1,77 bulundu. CHA2DS2-VASC skoru ≥2 olup mutlak olarak pıhtı önleyici kullanması gereken 108 hastadan 71 (%65,7) hasta varfarin ve 1 (%0,9) hasta rivaroksaban kullanmaktaydı. Hastaların 66 (%51,6)sı aspirin kullanmaktaydı. Varfarin başlandığı halde tedaviyi bırakma oranı %10,2 bulundu. Retrospektif olarak incelenen İNR değerleri, hastaların %71,1inde terapotik hedefinin sağlandığı görüldü. Sonuç: Kardiyoloji polikliniğinde AF tanısıyla takip ve tedavi edilen hastaların verileri, ESC kılavuzunun dikkate alındığını, ancak varfarin etkinliği takibinin zorluğu ve ilaç-gıda etkileşimi gibi çekinceler nedeniyle önemli oranda hastanın oral antikoagülan kullanmayıp bunun yerine kılavuzda önerilenden daha fazla oranda aspirin kullandığı tesbit edildi.

A survey of concordance of anticoagulant therapy administration in atrial fibrillation according to guidelines: A secon- dary care center experience

Objective: Atrial fibrillation (AF) is the most prevalent permanent rhythm disturbance. For the diagnosis and treatment of AF numerous guidelines have been published. The data about implementation of risk calculation table (CHA2DS2-VASC score) which was suggested by European Society of Cardiology (ESC) for prevention of stroke is very limited. Our aim was to document the data about implementation of guidelines and CHA2DS2- VASC score in AF treatment by cardiology specialists. Material and Method: The patients who were following up with diagnosis of AF that were admitted to cardiology outpatient units in 2012 were retrospectively included into present study. With registration of clinical and demographic properties of patients CHA2DS2-VASC scores and treat- ment applications were investigated. According to the result of International Normalized Ratio (INR) workup at last 1 year, the success of anticoagu- lant therapy was evaluated. Results: In the year of 2012 among 2303 patients who were admitted to cardiology outpatient clinic, 137 (6.2%) patients were diagnosed with AF. Of 128 patients that were recruited to study, 83 (64.8%) were women. Mean age was 67,5±10,9 years. Mean CHA2DS2-VASC score was found 3,36±1,77. Among 108 patients whose CHA2DS2-VASC was ≥2 and who have to use anticoagulant therapy, 71 (65.7%) patients were using warfari- ne and 1 (0.9%) was using rivoraxaban. Sixty six patients (51.6 %) were using acetylsalicilic acid. Even though warfarine was initiated, discontinua- tion rate of treatment was 10.2%. According to retrospective evaluation of INR levels, it was seen that in 71.1% of patients theraupetic targets were established. Conclusion: Data of patients who were following up and treated with diagnosis of AF in cardiology outpatient clinic showed that ESC guidelines were taken into consideration, but difficulty in follow up of warfarine efficacy and concerns about drug-food interactions lead important number of patients not to use oral anticoagulation, but instead lead them to use acetilysalicilic acid in higher rates of guideline suggestions.

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