Evaluation of antithrombotic usage for atrial fibrillation in aged care facilities
Evaluation of antithrombotic usage for atrial fibrillation in aged care facilities
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DOI：
10.1111/j.1365-2710.2010.01167.x
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发表时间：
2011-04-01
影响因子：
2
通讯作者：
Bereznicki, L. R.
中科院分区：
文献类型：
--
作者：
Singh, P.;Arrevad, P. S.;Bereznicki, L. R.
已知内容和目的：华法林是一种重要的药物，用于预防房颤患者的血栓栓塞性事件，如中风。然而，它通常与重大药物不良事件有关，这可能导致不愿开华法林，特别是在住院的老年人口中。这项研究旨在评估澳大利亚塔斯马尼亚州老年护理机构(ACF)房颤抗血栓治疗的当前趋势，并将其与当前的建议进行比较。方法：我们进行了一项非实验性的回顾性队列研究，旨在评估塔斯马尼亚老年护理机构(ACF)居民房颤的抗血栓使用情况。患有房颤的居民是从塔斯马尼亚州29家ACF的居民病历摘要中逐个患者确定的。CHADS-2评分和有无记录的禁忌症被用来确定当前抗血栓治疗的适宜性。结果和讨论：15%(262/1737)的ACF居民被诊断为房颤。9%的房颤患者有抗血栓治疗(华法林或抗血小板治疗)的禁忌症。根据CHADS-2评分，81%的居民有资格接受华法林治疗，而且似乎没有华法林的禁忌症。在这些患者中，只有38%的人开了华法林；16%(40/255)的人没有接受任何抗血栓治疗，尽管他们有资格接受华法林或抗血小板治疗。未接受任何抗血栓治疗或接受抗血小板治疗的居民明显比接受抗凝治疗的患者年龄大。最新和结论：我们的结果表明，抗血栓治疗，特别是华法林，在符合治疗条件的ACF老年患者中使用不足。
P>What is known and Objective:Warfarin is an important drug for the prevention of thromboembolic events such as stroke in patients with atrial fibrillation (AF). However, it is commonly implicated in major adverse drug events, which may result in reluctance to prescribe warfarin, especially in the institutionalised elderly population. This study aimed to assess the current trends in the antithrombotic management of AF in aged care facilities (ACFs) in Tasmania, Australia, and to compare this with current recommendations.Methods:We performed a non-experimental, retrospective cohort study designed to evaluate antithrombotic usage for AF in ACF residents in Tasmania. Residents with AF were identified on a patient-by-patient basis from residential case-note summaries collected from 29 of the 64 ACFs in Tasmania. The CHADS-2 score and the presence or absence of documented contraindications were used to determine the appropriateness of the current antithrombotic therapy prescribed.Results and Discussion:Fifteen per cent (262/1737) of the ACF residents were diagnosed with AF. Nine per cent of the residents with AF had a contraindication to antithrombotic therapy (either warfarin or antiplatelet therapy). Eighty-one per cent of residents were eligible for treatment with warfarin according to the CHADS-2 score and did not appear to have a contraindication to warfarin. Of these, only 38% were prescribed warfarin; 16% (40/255) did not receive any antithrombotic treatment, despite being eligible for treatment with warfarin or antiplatelet therapy. Residents who did not receive any antithrombotic treatment or who received antiplatelet treatment were significantly older than those treated with anticoagulants.What is new and Conclusion:Our results indicate that antithrombotic therapy, particularly warfarin, is underused in ACF-dwelling elderly patients who are eligible for treatment.