Effectiveness of Vitamin K antagonist for secondary prophylaxis of brain stroke in patients with atrial fibrillation in routine public care settings

Miftari, Visar and Vavlukis, Marija and Miftari, Visar and Ismani, Ekrem and Serafimov, Aleksandar (2020) Effectiveness of Vitamin K antagonist for secondary prophylaxis of brain stroke in patients with atrial fibrillation in routine public care settings. Medicus International Medical Journal, 25 (3). pp. 413-419. ISSN 1409-6366

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Abstract

Vitamin K antagonists are the mainstay for prevention of strokes in patients with atrial fibrillation (AF)
world-wide. Yet estimates on its effectiveness are heterogeneous and reveal stark differences between different
health-care systems. The aim of the present study was to assess the laboratory parameters for achieving the goal
of the therapy (Time in therapeutic range – TTR) and to describe the effectiveness of the therapy in real-time
setting.
Methods : Patients treated in our clinic, with confirmed AF were considered in the study. The study was prospective
observational study by design, where the participants were assessed at baseline for known risk factors for stroke,
diagnosis for atrial fibrillation, use of anticoagulant medication and presence of identifiable ischemic lesions in
the brain with non-contrast computed tomography (NCCT). The drug of choice was acenocoumarol, with planned
monthly measurements of INR with the duration of 6 months, and the study was concluded with additional NCCT
at the end, in order to assess for differences.
Results : 96 patients finished the observation. The mean age of the patients was 64.5 years (SD = 6.36), and 50 (52%)
were male. Regarding the INR measurement, we collected data from 88.2% of the planed measurements; 69.7% of
the patients achieved TTR above 60%. Cross-comparison between groups (TTR < 59% and TTR > 60%) revealed that
the first group had statistically significant higher proportion of patients with newly registered lesions on NCCT
(p-value < 0.05).
Conclusion: Acenocoumarol is the only therapeutic VKA option in our country, despite the availability of other
VKA antagonists that show better indices for effectiveness. Our sample confirmed that the proper use of VKA
significantly reduces the incidence of new NCCT ischemic lesions in conditions of routine public health care.

Item Type:	Article
Subjects:	Medical and Health Sciences > Clinical medicine Medical and Health Sciences > Health sciences
Divisions:	Faculty of Medical Science
Depositing User:	Aleksandar Serafimov
Date Deposited:	22 Aug 2022 09:21
Last Modified:	22 Aug 2022 09:21
URI:	https://eprints.ugd.edu.mk/id/eprint/30072

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