Thực trạng sử dụng thuốc chống huyết khối trong dự phòng đột quỵ trên người bệnh rung nhĩ

Identify the using rate of antithrombotics in nonvalvular AF patients based on the stroke risk stratification CHA2DS2-VASc.. Identify the using rate of antithrombotics in nonvalvular AF

‘REAL-LIFE’ USE OF ANTITHROMBOTICS IN ATRIAL FIBRILLATION PATIENTS FOR

STROKE PREVENTION AT CHO RAY HOSPITAL

NGUYEN THE QUYEN Prof NGUYEN VAN TRI

BACKGROUND

Good efficacy of Vitamin K Antagonist (VKA):

• Nonvavular AF: reduce stroke risk over 2.5 times 1

• Valvular AF: embolic events decrease 4 – 15 times 2

However, previous studies of using VKA remains low in Vietnam:

• Nonvavular AF: 7 – 13% use 3

• Valvular AF: 34% 4

This study will re-evaluate the situation

1 Camm AJ, et al Eur Heart J 2010;31:2369-429

2 Bonow RO, et al J Am Coll Cardiol 2008;52:e1-142

3 Pham Chi Linh, Nguyen Van Si HCMC University of Medical and Pharmacy 2011

4 Le Hoai Nam Y Hoc Tp.Ho Chi Minh 2014;18:209-14

ACC 2014

Optional

A score ≥ 3 is considered “high bleeding risk” ESC recommends “caution” using OACs

STUDY OBJECTIVES

1 Identify the using rate of antithrombotics in nonvalvular AF patients based on

the stroke risk stratification CHA2DS2-VASc

2 Identify the using rate of antithrombotics in nonvalvular AF patients based on

the bleeding risk stratification HAS-BLED

3 Identify the using rate of VKA in valvular AF patients based on the bleeding risk

stratification HAS-BLED

STUDY METHODS

1 Study design

Prospective, cross-sectional study

2 Study population

All patients who were diagnosed AF during admission into Cho Ray hospital

from October 2013 to May 2014

STUDY PROCESS

RESULTS

Population Nonvalvular AF Valvular AF

132 (51,2) 41 (31,1) Female 126 (48,8) 91 (68,9)

Identify the using rate of antithrombotics in nonvalvular AF

Objective 1

Stroke risk stratification CHA2DS2-VASc

The use of antithrombotics based on CHA2DS2-VASc score

Reference value Compared value OR 95% CI p

Use VKA

CHA2DS2-VASc < 2 CHA2DS2-VASc ≥ 2

1,48 0,78 – 2,82 0,234

The univariate relationship between CHA2DS2-VASc and

antithrombotic use in nonvalvular AF patients

Not follow the current guideline

Identify the using rate of antithrombotics in nonvalvular AF patients based on the bleeding risk stratification HAS-BLED

Objective 2

2.1.2 tình hình sử dụng thuốc chống huyết khối The use of antithrombotics based on HAS-BLED score

HAS-BLED = 0 use OAC

% patients with BLED = 1 – 2 use OAC

% patients with BLED ≥ 3 use OAC

Reference value Compared value OR 95% CI p

Use VKA

HAS-BLED ≤ 2 HAS-BLED > 2

0,57 0,23 – 1,43 0,232

The univariate relationship between HAS-BLED and

antithrombotic use in nonvalvular AF patients

Not follow the current guideline

Our study Reference value Compared value OR 95% CI p Use OAC

The multivariate relationship between CHA2DS2-VASc, HAS-BLED and

antithrombotic use in nonvalvular AF patients

Not follow the current guideline

Identify the using rate of VKA in valvular AF patients based on the bleeding risk stratification HAS-BLED

Objective 3

Bleeding risk stratification HAS-BLED

HAS-BLED score rises

CONCLUSION

In nonvalvular AF population, many patients need

And most of them have little bleeding risk (90,7%

HAS-BLED ≤ 2), however the using rate of VKA

remains low (42,5%)

In valvular AF population, the using rate of VKA really achieves actual success (94%)