A prospective study investigating the causes of warfarin under-utilization in Chinese patients

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• 作者：Shujuan Zhao ; Hongwei Zhao ; Xianpei Wang…
• 关键词：Atrial fibrillation ; Atrial flutter ; China ; Prevention ; Stroke ; Warfarin
• 刊名：Pharmacy World Science
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：38
• 期：5
• 页码：1286-1293
• 全文大小：572 KB
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Internal Medicine
  Pharmacy
  
• 出版者：Springer Netherlands
• ISSN：2210-7711
• 卷排序：38

文摘

Background Warfarin is efficacious for ischemic stroke prevention in intermediate- to high-risk patients with atrial fibrillation; thus, warfarin is the recommended treatment according to evidence-based guidelines. Objective This prospective study evaluated the reasons for under-utilization of warfarin in Chinese patients with non-valvular atrial fibrillation (NVAF). Setting The People’s Hospital of Henan Province of Zhengzhou City, which is a 3900-bed tertiary-care teaching institution. Methods We extracted data from an existing patient database. Patients at risk for thromboembolism were categorized based on CHA₂DS₂-VASc [congestive heart failure, hypertension, age ≥75 (doubled), diabetes, prior stroke (doubled), vascular disease, age 65–74 years, and sex category (female)] scores. Main outcome measure The percent of warfarin utilization was estimated in recruited patients. Any demographic and clinical factors associated with warfarin under-utilization were identified using a logistic regression model. Results Among the patient sample (n = 612), 569 patients had a CHA₂DS₂-VASc score of ≥1. At presentation, warfarin under-utilization was estimated to be 27.1 %. Only 120 patients (25.1 %) considered to be at the highest risk were prescribed warfarin. Binary logistic regression analysis indicated that previous stroke, age ≥75 years, and anti-platelet therapy were associated with warfarin under-utilization. Conclusion Patients with CHA₂DS₂-VASc scores ≥1 who were admitted with NVAF were under prescribed warfarin, and 138 patients were not treated with either warfarin or other antithrombotic therapies. In conclusion, a more aggressive approach for stroke prevention in NVAF patients is required.