Nuevos anticoagulantes: ¿cuántos de nuestros pacientes anticoagulados pueden tomarlos?

Abstract

New anticoagulants: how many of our anticoagulated patients can take them? Objective. To establish the percentage of patients with non-valvular atrial fibrillation (AF) on Oral Anticoagulant Therapy subject to new oral anticoagulants, and in how many of them the change would be cost-effective. Material and Methods. Observational, descriptive and cross-sectional study in the area of primary care (Centro de Salud de Manzanares II) on 94 patients (52 males and 42 female) with “anticoagulation” and atrial fibrillation (AF) risk factor by the collection of clinical history (sociodemographic, clinical analytical) data and application of CHADS2 y CHAD2DS2-VASc scores, assessing prescription based on scores. Results. 92,5% are over 65 years of age and 66% over 75. There is a very high rate of High Blood Pressure (78,7%), Diabetes Mellitus (41,4%), Chronic Kidney Disease (34%), Heart Failure (26,5%) and Thrombopenia (11,7%). 4,2% have a glomerular filtration below 30 ml/min and 12,7% between 30-50 ml/min. Out of those over 65, 67% have High Blood Pressure, 35,1% Diabetes Mellitus and 21,2%, Heart Disease. CHADS2 scale values (2,46±1.27 points) with ≥2 points (76,5%). They take drugs with a possible interaction (amiodarone or verapamil) of 5,3%. The INR is at <60% of Therapeutic Range Time at 40,2% (IC95%: 30,4-51,0) of patients which, coupled with the CHADS2 values (1, 2 or ≥3 points: 5,3%, 10.6 y 17% respectively), makes the new anticoagulant cost-effective in 32,9% of patients. Conclusions. The new oral anticoagulants could be indicated in up to two out of three patients with non-valvular AF. They would be contraindicated in 4% of cases, and precaution is necessary in one out of eight patients, due to impaired renal function. Its use would be cost-effective in up to one out of three patients.