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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
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26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
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30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
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Assessment of Novel Oral Anticoagulant Use in Real-world Setting: Importance of a structured Anticoagulation Unit
Session:
Posters 5 - Écran 10 - Cardiologia Clínica/Miscelânia
Speaker:
Madalena Coutinho Cruz
Congress:
CPC 2018
Topic:
L. Cardiovascular Pharmacology
Theme:
31. Pharmacology and Pharmacotherapy
Subtheme:
31.5 Pharmacology and Pharmacotherapy - Other
Session Type:
Posters
FP Number:
---
Authors:
Madalena Coutinho Cruz; André Viveiros Monteiro; Pedro Silva Cunha; Sílvia Aguiar Rosa; Luís Almeida Morais; Paula Malveiro; Mário Martins Oliveira; Rui Cruz Ferreira
Abstract
<p><strong>Introduction:</strong> Non-vitamin K antagonist oral anticoagulants (NOAC) are considered to have predictable pharmacokinetics, a lack of food interference and fewer drug interactions, allowing for standardized dosing without monitoring. However, their misuse could potentially result in patient harm, particularly in the elderly and patients with renal impairment. We aimed to analyze NOAC dosing patterns in a real-world setting and the effectiveness and safety of a structured follow-up in a recently created nurse-based NOAC Anticoagulation Unit with medical surveillance with focus on high-risk patients.</p> <p><strong>Methods:</strong> All consecutive patients followed in a NOAC Anticoagulation Unit of a single tertiary university hospital between August 2016 and August 2017 were identified. Patients were referred by their attending physician for reasons such as low glomerular filtration rate, advanced age or history of previous bleeding. Each visit comprised a clinical questionnaire and blood analysis. Subsequent visits were scheduled according to the results.</p> <p><strong>Results:</strong> One hundred and eight patients (67.3% male, mean age 74.9 years, 81.5% atrial fibrillation) were analyzed. At first visit, mean glomerular filtration rate was 52.6 ± 12.0 mL/min and 40 patients (37.0%) had a glomerular filtration rate < 60 ml/min. The most commonly prescribed NOAC were apixaban (63.0%) and rivaroxaban (24.1%). 55 (50.9%) patients were medicated by their attending physician with reduced doses. Bleeding events occurred in 15 patients (13.9%), without major events, and ischemic episodes in 5 patients (4.6%) during a mean follow-up of 8 months and a total of 620 visits. Three deaths were reported (one due to a massive stroke). According to renal function, label-discordant dosing was observed in 35% of patients. In patients with renal dysfunction, lack of renal dose-adjustment was seen in 9.3% of patients. In 25.9% of patients with preserved renal function, underdosing was documented. However, when comparing patients with renal function-adjusted dose and non-adjusted dose, there was not a significant increase in bleeding (18.2 vs. 13.4%, p=ns) or stroke events (0 vs. 6.3%, p=ns). Finally, 12 patients (11.1%) reported a temporary interruption of the NOAC mainly attributed to drug-specific side effects and minor bleeding. All the discontinued patients proceeded with other types of oral anticoagulants.</p> <p><strong>Conclusions:</strong> In routine clinical practice, prescribed NOAC doses are often inconsistent with drug labelling, mainly in patients with preserved renal function, putting them at risk of embolic events. Furthermore, despite standardized dosing, irregular medication adherence is not rare. A structured follow-up with regular monitoring of renal function and drug compliance, with associated judicious dose or medication adjustments, could reduce potential complications.</p>
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