Terapijski učinak varfarina kod bolesnika s fibrilacijom atrija

master's thesis

• Title (english): Therapeutic effect of warfarin in patients with atrial fibrillation
• Author: Ivana Ježić
• Mentor: Anton Šmalcelj (mentor)
• Committee member: Davor Puljević (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Anton Šmalcelj (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Fibrilacija atrija (FA) smatra se najčešćom aritmijom u kliničkoj praksi. Može biti praćena tromboembolijskim komplikacijama koje često mogu biti uzrok smrti pacijenta. Najteža komplikacija zasigurno je moždani udar, koji je poželjno prevenirati. Neka istraživanja pokazuju da se 2/3 moždanih udara može spriječiti primjenom adekvatne antikoagulantne terapije (AVK i NOAK). Prikupljeni su podaci 743 pacijenata s nevalvularnom, od ranije dijagnosticiranom FA koji su na KBC Zagreb bili upućeni iz svih krajeva RH. Postavljena je hipoteza prema kojoj terapijski učinak antikoagulantih lijekova odgovara adekvatnoj terapijskoj preporuci te ESC smjernicama.
Rezultati dobiveni istraživanjem su pomalo iznenađujući. Ukupno 75.5% pacijenata imalo je adekvatnu preporuku za terapiju (AVK i NOAK), međutim samo 31.4% pacijenata imalo je PV-INR vrijednost unutar preporučenog terapijskog raspona. Dakle, prema preporučenoj terapiji nalazimo se ispred mnogo razvijenijih krajeva poput Sjeverne Amerike i Zapadne Europe, ali prema terapijskom efektu smo iza Indije i Kine. Također, pacijenti s drugim komorbiditetima, poput HA, DM te oni koji imaju HAS-BLED vrijednosti ≥ 3 češće su neadekvatno antikoagulirani.
Zaključak je da učinkovitost farmakološke prevencije tromboembolijskih komplikacija FA znatno zaostaje za rezultatima dobivenim u zapadnim zemljama. Dobiveni podaci pokazatelji su nam kako i gdje poboljšati antikoagulantnu terapiju.

Abstract (english)

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice. It can be associated with mortality, largely due to its thromboembolic complications. Disabling stroke is the most severe of them. Some of the research sugest that appropriate anticoagulant therapy (VKA and NOAC) reduces the risk of thromboembolism by two thirds.
The relevant data was collected from 743 patients with nonvalvular, previously diagnosed AF being referred to KBC Zagreb from all the regions of Croatia. It was hypothesized that the therapeutic effect of anticoagulant drugs corresponds with adequate therapeutic recommendationand the ESC guidelines.
The obtained results were in many ways unexpected. Total 75.5% of patients had adequate therapy recommendation (VKA and NOAC), but only 31.4% of them had a PT-INR value within recommended therapeutic range. Therfore, according to the treatment recommendation we are in front of the much more developed regions, such as North America and Western
Europe, but due to the therapeutic effect we are behind Indica and China. Also, patients with other comorbidities, such as HA, DM and those with HAS-BLED score ≥ 3 are more often inadequately anticoagulated.
The conclusion is that the effectiveness of pharmacological prevention of thromboembolic complications of AF in Croatia lags significantly behind the results shown in Western countries, but also offers the clues how and where to improve the treatment strategies.

• Keywords: fibrilacija atrija; terapijski učinak; PV-INR vrijednost
• Keywords (english): atrial fibrillation; INR; prevention of thromboembolic complications
• Language: croatian
• URN:NBN: urn:nbn:hr:105:202507
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-08-10 09:24:24