Average CHA2DS2-VASc Score Research Articles

Administration tri-hebdomadaire de la warfarine en hémodialyse chronique. Résultats chez 12 patients

We report our experience of thrice-weekly warfarin administration, at the end of the dialysis session, in 12 patients (average age: 79±5years). In 10 cases, indication for anticoagulation therapy was atrial fibrillation, in one case a mechanical heart valve, in another case axillo femoral bypass. The International Normalized Ratio (INR) therapeutic goal was between 2 and 3, except for the patient with a mechanical aortic heart valve, whose goal was between 2.5 and 3.5. The INR was determined during the first dialysis session of the week. The thrice-weekly warfarin dose was based on this result. INR stability was assessed for each patient over an uninterrupted period of treatment of at least 6months. The average duration of warfarin treatment was 20±5months. One in two patients had hypertensive nephropathy. The average Charlson co-morbidity score was 9±1. Four patients were also taking aspirin or clopidogrel. The 10 patients with atrial fibrillation had an average CHA2DS2-VASc score of 4.4±0.8. The average haemorrage risk HAS-BLED score was 3.3±0.6. The average weekly warfarin dose was 23±5mg. No thrombotic events were observed. The side effects of warfarin were minor in most cases: (1) INR more than 6 in two cases without associated bleeding; (2) minor bleeding (nose, bladder) in three cases. One case of skin necrosis was observed. No cases of major bleeding (requiring blood transfusion) were observed. Only one patient was admitted into hospital as a result of warfarin treatment (the case of skin necrosis). Five hundred and forty-seven INR results were analyzed: 65% of these results were within the therapeutic goal, only 3% were either beneath 1.5 or over 4. To conclude, warfarin administration at the end of the dialysis session is efficient and associated with remarkable INR stability in the goal. It enables precise dose adaptation and optimum therapeutic observance, which in turn reduces the risk of bleeding.

Proportion of Patients with Implanted Permanent Pacemakers with Atrial Fibrillation Receiving Appropriate Medical Prophylaxis in North Wales

Atrial fibrillation (AF) is associated with an increased long-term risk of stroke, heart failure, and mortality. Previous studies have demonstrated the suboptimal use of anticoagulation therapy in patients with AF. A retrospective survey of patients (N = 1,113) fitted with dual-chamber pacemakers found 71 patients (age 69 ± 35, mean ± standard deviation) with atrial tachycardia and AF (defined as >5 minutes per day). Their medical records and anticoagulation status were investigated and used to stratify each patient for stroke risk with the Birmingham 2009 schema (CHA(2)DS(2)-VASc) and assessed to determine the rate of appropriate thromboembolism (TE) prophylaxis prescription. The most common overall concomitant risk factor for stroke was hypertension (54%), followed by age ≥75 (51%), being female and previous stroke/transient ischemic attack/TE (39%). The average CHA(2)DS(2)-VASc score was 3.7 ± 1.6. Fifty-six percent of the patients were not receiving appropriate anticoagulation therapy. This study demonstrates an underutilization of the oral anticoagulant warfarin in patients with known AF and that the clinicians may not be regarding current stroke risk factors when adopting a thromboprophylaxis strategy.