Efficiency of the Decision-Making Module in the Personalized Choice of an Anticoagulant
https://doi.org/10.18087/cardio.2021.3.n1511
Abstract
Aim To evaluate the effectiveness of the decision-making module in selecting an oral anticoagulant for patients with atrial fibrillation.
Material and methods 638 patients with atrial fibrillation aged 68.2±4.5 years were evaluated. The CHA2DS2-VASc, HAS-BLED, and 2MАСЕ scales, the creatinine clearance calculator, and the Morisky-Green questionnaire were used.
Results 311 (48.75 %) patients had paroxysmal atrial fibrillation, 138 (21.6%) had persistent atrial fibrillation, 44 (22.7%) had long-standing persistent atrial fibrillation, and 145 (22.7 %) had permanent atrial fibrillation. Mean CHADS2‑VASc scale score was 4.82; НAS-BLED scale score was 2.9; 2MACE score was 2.28; and compliance score was 3.52. 172 (26.9 %) patients were treated with rivaroxaban; 166 (26 %), with apixaban; 84 (13.2 %), with dabigatran; 210 (32.9 %), with warfarin; and 6 (1 %), with acetylsalicylic acid.
Conclusion The developed decision-making module is based on scientific justification of personalized selection of the oral anticoagulant and updates the knowledge on major issues of prescription.
Supporting agencies: No conflict of interest is reported.
About the Authors
E. V. Gorbunova
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
Russian Federation
Russian Federation
PhD, leading researcher at the Laboratory of Cardiac Arrhythmias and Pacing
S. P. Duvanova
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
Russian Federation
Russian Federation
a resident
K. M. Filimonov
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
Russian Federation
Russian Federation
a resident
S. E. Mamchur
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
Russian Federation
Russian Federation
Head of the Laboratory of Cardiac Arrhythmias and Pacing
S. A. Makarov
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
Russian Federation
Russian Federation
PhD, Head of the Laboratory for Modeling Medical Technologies
References
1. Gorbunova E.V., Odarenko Yu.N., Mamchur S.E., Kudryavtseva N.G., Salahov R.R. Improving efficiency and safety of anticoagulation therapy in patients with prosthetic heart valves. Complex Issues of Cardiovascular Diseases. 2015;4:26–33.
2. Camm A, Coleman C, Larsen T, Nielsen P, Tamayo C. Understanding the Value of Real-World Evidence: Focus on Stroke Prevention in Atrial Fibrillation with Rivaroxaban. Thrombosis and Haemostasis. 2018;118(S 01):S45–60. DOI: 10.1055/s-0038-1635084
3. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström- Lundqvist C et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). European Heart Journal. 2020;42(5):373–498. DOI: 10.1093/eurheartj/ehaa612
4. Andrade J, Khairy P, Dobrev D, Nattel S. The Clinical Profile and Pathophysiology of Atrial Fibrillation: Relationships Among Clinical Features, Epidemiology, and Mechanisms. Circulation Research. 2014;114(9):1453–68. DOI: 10.1161/CIRCRESAHA.114.303211
5. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983–8. DOI: 10.1161/01.STR.22.8.983
6. Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New England Journal of Medicine. 2011;365(10):883–91. DOI: 10.1056/NEJMoa1009638
7. Kirchhof P, Ammentorp B, Darius H, De Caterina R, Le Heuzey J-Y, Schilling RJ et al. Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events – European Registry in Atrial Fibrillation (PREFER in AF). EP Europace. 2014;16(1):6–14. DOI: 10.1093/europace/eut263
8. Hanon O, Jeandel C, Jouanny P, Paccalin M, Puisieux F, Krolak- Salmon P et al. Anticoagulant treatment in elderly patients with atrial fibrillation: position paper. Gériatrie et Psychologie Neuropsychiatrie du Viellissement. 2019;17(4):341–55. DOI: 10.1684/pnv.2019.0834
9. Friberg L, Rosenqvist M, Lip GYH. Net Clinical Benefit of Warfarin in Patients With Atrial Fibrillation: A Report From the Swedish Atrial Fibrillation Cohort Study. Circulation. 2012;125(19):2298–307. DOI: 10.1161/CIRCULATIONAHA.111.055079
10. Benjamin EJ, Levy D, Vaziri SM, D’Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994;271(11):840–4. DOI: 10.1001/jama.1994.03510350050036
11. Du X, Ninomiya T, de Galan B, Abadir E, Chalmers J, Pillai A et al. Risks of cardiovascular events and effects of routine blood pressure lowering among patients with type 2 diabetes and atrial fibrillation: results of the ADVANCE study. European Heart Journal. 2009;30(9):1128–35. DOI: 10.1093/eurheartj/ehp055
12. Fox KAA, Piccini JP, Wojdyla D, Becker RC, Halperin JL, Nessel CC et al. Prevention of stroke and systemic embolism with rivaroxaban compared with warfarin in patients with non-valvular atrial fibrillation and moderate renal impairment. European Heart Journal. 2011;32(19):2387–94. DOI: 10.1093/eurheartj/ehr342
13. Coleman CI, Kreutz R, Sood NA, Bunz TJ, Eriksson D, Meinecke A-K et al. Rivaroxaban Versus Warfarin in Patients With Nonvalvular Atrial Fibrillation and Severe Kidney Disease or Undergoing Hemodialysis. The American Journal of Medicine. 2019;132(9):1078– 83. DOI: 10.1016/j.amjmed.2019.04.013
14. Bonnemeier H, Huelsebeck M, Kloss S. Comparative effectiveness of rivaroxaban versus a vitamin K antagonist in patients with renal impairment treated for non-valvular atrial fibrillation in Germany – A retrospective cohort study. IJC Heart & Vasculature. 2019;23:100367. DOI: 10.1016/j.ijcha.2019.100367
15. Pastori D, Farcomeni A, Poli D, Antonucci E, Angelico F, Del Ben M et al. Cardiovascular risk stratification in patients with non-valvular
16. atrial fibrillation: the 2MACE score. Internal and Emergency Medicine. 2016;11(2):199–204. DOI: 10.1007/s11739-015-1326-1
17. Mak K-H. Coronary and mortality risk of novel oral antithrombotic agents: a meta-analysis of large randomised trials. BMJ Open. 2012;2(5):e001592. DOI: 10.1136/bmjopen-2012-001592
18. Loke YK, Pradhan S, Yeong JK, Kwok CS. Comparative coronary risks of apixaban, rivaroxaban and dabigatran: a meta-analysis and adjusted indirect comparison. British Journal of Clinical Pharmacology. 2014;78(4):707–17. DOI: 10.1111/bcp.12376
19. Tornyos A, Kehl D, D’Ascenzo F, Komócsi A. Risk of Myocardial Infarction in Patients with Long-Term Non-Vitamin K Antagonist Oral Anticoagulant Treatment. Progress in Cardiovascular Diseases. 2016;58(5):483–94. DOI: 10.1016/j.pcad.2015.12.001
20. Sabatini T, Frisoni GB, Barbisoni P, Bellelli G, Rozzini R, Trabucchi M. Atrial Fibrillation and Cognitive Disorders in Older People. Journal of the American Geriatrics Society. 2000;48(4):387–90. DOI: 10.1111/j.1532-5415.2000.tb04695.x
21. Kwok CS, Loke YK, Hale R, Potter JF, Myint PK. Atrial fibrillation and incidence of dementia: A systematic review and meta-analysis. Neurology. 2011;76(10):914–22. DOI: 10.1212/WNL.0b013e31820f2e38
22. Kokkinidis DG, Zareifopoulos N, Theochari CA, Arfaras-Melainis A, Papanastasiou CA, Uppal D et al. Association Between Atrial Fibrillation and Cognitive Impairment in Individuals With Prior Stroke: A Meta-Analysis and Meta-Regression Analysis. Stroke. 2020;51(6):1662–6. DOI: 10.1161/STROKEAHA.119.027815
23. Rivard L, Khairy P. Mechanisms, Clinical Significance, and Prevention of Cognitive Impairment in Patients With Atrial Fibrillation. Canadian Journal of Cardiology. 2017;33(12):1556–64. DOI: 10.1016/j.cjca.2017.09.024
24. Hui DS, Morley JE, Mikolajczak PC, Lee R. Atrial fibrillation: A major risk factor for cognitive decline. American Heart Journal. 2015;169(4):448–56. DOI: 10.1016/j.ahj.2014.12.015
25. Mongkhon P, Naser AY, Fanning L, Tse G, Lau WCY, Wong ICK et al. Oral anticoagulants and risk of dementia: A systematic review and meta-analysis of observational studies and randomized controlled trials. Neuroscience & Biobehavioral Reviews. 2019;96:1–9. DOI: 10.1016/j.neubiorev.2018.10.025
26. Brown JD, Shewale AR, Talbert JC. Adherence to Rivaroxaban, Dabigatran, and Apixaban for Stroke Prevention for Newly Diagnosed and Treatment-Naive Atrial Fibrillation Patients: An Update Using 2013-2014 Data. Journal of Managed Care & Specialty Pharmacy. 2017;23(9):958–67. DOI: 10.18553/jmcp.2017.23.9.958
27. Kirchhof P, Radaideh G, Kim Y-H, Lanas F, Haas S, Amarenco P et al. Global Prospective Safety Analysis of Rivaroxaban. Journal of the American College of Cardiology. 2018;72(2):141–53. DOI: 10.1016/j.jacc.2018.04.058
28. Zedler BK, Kakad P, Colilla S, Murrelle L, Shah NR. Does Packaging with a Calendar Feature Improve Adherence to Self- Administered Medication for Long-Term Use? A Systematic Review. Clinical Therapeutics. 2011;33(1):62–73. DOI: 10.1016/j.clinthera.2011.02.003
29. Lau WCY, Douglas IJ, Wong ICK, Smeeth L, Lip GYH, Leung WK et al. Thromboembolic, bleeding, and mortality risks among patients with nonvalvular atrial fibrillation treated with dual antiplatelet therapy versus oral anticoagulants: A population-based study. Heart Rhythm. 2020;17(1):33–40. DOI: 10.1016/j.hrthm.2019.07.034
Review
For citations:
Gorbunova E.V., Duvanova S.P., Filimonov K.M., Mamchur S.E., Makarov S.A. Efficiency of the Decision-Making Module in the Personalized Choice of an Anticoagulant. Kardiologiia. 2021;61(3):18-22. https://doi.org/10.18087/cardio.2021.3.n1511
Views:
1062
Email this article 
Post a Comment 
