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Anticoagulation Control with Acenocoumarol or Warfarin in Non-Valvular Atrial Fibrillation in Primary Care (Fantas-TIC Study)

Author

Listed:
  • M. Rosa Dalmau Llorca

    (Equip d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
    Campus Terres de l’Ebre, Universitat Rovira i Virgili, 43500 Tortosa, Tarragona, Spain
    Primary Care Intervention Evaluation Research Group (GAVINA Research Group), 43500 Tortosa, Tarragona, Spain
    Co-senior authors: M.R. Dalmau Llorca, C. Aguilar Martín, A.Q. Gonçalves and J. Fernández-Sáez. M.R. Dalmau Llorca is the Principal Investigator of this study.)

  • Carina Aguilar Martín

    (Primary Care Intervention Evaluation Research Group (GAVINA Research Group), 43500 Tortosa, Tarragona, Spain
    Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
    Unitat d’Avaluació, Direcció d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
    Co-senior authors: M.R. Dalmau Llorca, C. Aguilar Martín, A.Q. Gonçalves and J. Fernández-Sáez. M.R. Dalmau Llorca is the Principal Investigator of this study.)

  • Noèlia Carrasco-Querol

    (Primary Care Intervention Evaluation Research Group (GAVINA Research Group), 43500 Tortosa, Tarragona, Spain
    Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain)

  • Zojaina Hernández Rojas

    (Equip d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
    Campus Terres de l’Ebre, Universitat Rovira i Virgili, 43500 Tortosa, Tarragona, Spain
    Primary Care Intervention Evaluation Research Group (GAVINA Research Group), 43500 Tortosa, Tarragona, Spain)

  • Emma Forcadell Drago

    (Equip d’Atenció Primària Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
    Primary Care Intervention Evaluation Research Group (GAVINA Research Group), 43500 Tortosa, Tarragona, Spain)

  • Dolores Rodríguez Cumplido

    (Primary Care Intervention Evaluation Research Group (GAVINA Research Group), 43500 Tortosa, Tarragona, Spain
    Hospital Universitari de Bellvitge, Institut Català de la Salut, 08907 Barcelona, Spain)

  • Elisabet Castro Blanco

    (Campus Terres de l’Ebre, Universitat Rovira i Virgili, 43500 Tortosa, Tarragona, Spain
    Primary Care Intervention Evaluation Research Group (GAVINA Research Group), 43500 Tortosa, Tarragona, Spain)

  • Alessandra Queiroga Gonçalves

    (Primary Care Intervention Evaluation Research Group (GAVINA Research Group), 43500 Tortosa, Tarragona, Spain
    Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
    Unitat Docent de Medicina de Familia i Comunitària, Tortosa-Terres de l’Ebre, Institut Català de la Salut, 43500 Tortosa, Tarragona, Spain
    Co-senior authors: M.R. Dalmau Llorca, C. Aguilar Martín, A.Q. Gonçalves and J. Fernández-Sáez. M.R. Dalmau Llorca is the Principal Investigator of this study.)

  • José Fernández-Sáez

    (Campus Terres de l’Ebre, Universitat Rovira i Virgili, 43500 Tortosa, Tarragona, Spain
    Primary Care Intervention Evaluation Research Group (GAVINA Research Group), 43500 Tortosa, Tarragona, Spain
    Unitat de Suport a la Recerca Terres de l’Ebre, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Tarragona, Spain
    Unitat de Recerca, Gerència Territorial Terres de l’Ebre (Institut Catalá de la Salut), 43500 Tortosa, Tarragona, Spain)

Abstract

Introduction: The use of vitamin K antagonists (VKAs) in non-valvular atrial fibrillation (NVAF) is complicated due to the narrow therapeutic margin they present and their unpredictable dose–response relationship. Most studies are based on warfarin, with the results being extrapolated to acenocoumarol. However, studies comparing the two treatments in terms of the degree of anticoagulation control are scarce, justifying the present study. Main factors associated with poor control of time in therapeutic range (TTR) of anticoagulated patients are also studied. Methods: Cross-sectional study, with real-world data from patients treated in primary care (PC). Data were obtained from the System for the Improvement of Research in PC (SIDIAP) database, covering 60,978 NVAF-anticoagulated patients from 287 PC centres in 2018. Descriptive statistics were derived, and odds ratios were estimated by multivariate logistic regression. Results: 41,430 patients were considered: 93% were being treated with acenocoumarol and 7% with warfarin. There was no difference in poor control of TTR between the two types of VKA treatment, acenocoumarol and warfarin (38.9 vs. 38.4; p = 0.610). Poor anticoagulation control was mainly associated with advanced alcoholism (OR = 1.38), liver failure (OR = 1.37) and intracranial haemorrhage (OR = 1.35) as well as female sex, age < 60 years, cardiovascular history, diabetes mellitus and other variables. Conclusions: There is no association between poor anticoagulation control and the type of VKA treatment administered. Factors associated with poor control of TTR must be considered in clinical practice to improve control and decision-making.

Suggested Citation

  • M. Rosa Dalmau Llorca & Carina Aguilar Martín & Noèlia Carrasco-Querol & Zojaina Hernández Rojas & Emma Forcadell Drago & Dolores Rodríguez Cumplido & Elisabet Castro Blanco & Alessandra Queiroga Gonç, 2021. "Anticoagulation Control with Acenocoumarol or Warfarin in Non-Valvular Atrial Fibrillation in Primary Care (Fantas-TIC Study)," IJERPH, MDPI, vol. 18(11), pages 1-14, May.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:11:p:5700-:d:562536
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    References listed on IDEAS

    as
    1. Jean-Baptiste Briere & Olivia Wu & Kevin Bowrin & Aurélie Millier & Mondher Toumi & Vanessa Taieb & Pierre Lévy & Craig I. Coleman, 2019. "Impact of methodological choices on a meta-analysis of real-world evidence comparing non-vitamin K antagonist oral anticoagulants with vitamin K antagonists for the treatment of patients with non-valv," Post-Print hal-02271243, HAL.
    2. Craig I. Coleman & Jean-Baptiste Briere & Laurent Fauchier & Pierre Lévy & Kevin Bowrin & Mondher Toumi & Aurélie Millier & Vanessa Taieb & Olivia Wu, 2019. "Meta-analysis of real-world evidence comparing non-vitamin K antagonist oral anticoagulants with vitamin K antagonists for the treatment of patients with non-valvular atrial fibrillation," Post-Print hal-02273915, HAL.
    3. Juan Manuel Carmona‐Torres & Ana Isabel Cobo‐Cuenca & Beatriz Recio‐Andrade & José Alberto Laredo‐Aguilera & María Manuela Martins & María Aurora Rodríguez‐Borrego, 2018. "Prevalence and factors associated with polypharmacy in the older people: 2006–2014," Journal of Clinical Nursing, John Wiley & Sons, vol. 27(15-16), pages 2942-2952, August.
    4. M. Rosa Dalmau Llorca & Carina Aguilar Martín & Noèlia Carrasco-Querol & Zojaina Hernández Rojas & Emma Forcadell Drago & Dolores Rodríguez Cumplido & Josep M. Pepió Vilaubí & Elisabet Castro Blanco &, 2021. "Oral Anticoagulant Adequacy in Non-Valvular Atrial Fibrillation in Primary Care: A Cross-Sectional Study Using Real-World Data (Fantas-TIC Study)," IJERPH, MDPI, vol. 18(5), pages 1-16, February.
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