Elena Salas

Consorci Sanitari Barcelona, Barcino, Catalonia, Spain

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Publications (4)12.82 Total impact

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    ABSTRACT: Although there is consensus about the use of oral anticoagulants to prevent thrombi and embolisms in most patients with atrial fibrillation, this treatment is underused in actual practice. Our objective was to determine and analyze the use of acenocoumarol in patients diagnosed as having atrial fibrillation at discharge. Between January and July 2000, we retrospectively studied 501 consecutive patients with a diagnosis of atrial fibrillation. We recorded whether they were discharged with or without oral anticoagulation treatment. We identified 482 patients with at least one associated thromboembolic risk factor, who comprised the study population. Mean age was 79.3 years, and 33.3% of the patients were men. Forty-six percent were discharged with acenocoumarol, and 36.3% with platelet antiaggregants. Twenty-three percent had a known contraindication for acenoroumarol. Nearly 62% of the patients without contraindications for anticoagulation received treatment with acenocoumarol. Multivariate analysis showed that rheumatic mitral valve disease, previous stroke or thromboembolism and dilated left atrium were associated with a higher probability of receiving anticoagulant treatment. Age over 75 years was associated with a lower likelihood of receiving acenocoumarol. Oral anticoagulation was given in an inadequate proportion of patients who were discharged from a secondary-level hospital with atrial fibrillation and no contraindications. Rheumatic mitral valve disease, previous stroke or thromboembolism, and dilated left atrium were associated with a higher probability of anticoagulant treatment. Age over 75 years was related with less frequent use of this therapy.
    Revista Espa de Cardiologia 12/2003; 56(11):1057-63. · 3.20 Impact Factor
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    ABSTRACT: Few studies have attempted to investigate the clinical course or identify factors responsible for excessive anticoagulation in patients with heart disease. To determine the incidence of excessive anticoagulation in outpatients with heart disease treated with acenocoumarol, analyze the factors related with over-anticoagulation, and identify bleeding complications. This 7-month prospective observational study included consecutive outpatients anticoagulated with acenocoumarol. They were seen in an anticoagulation unit. The high INR group of 55 over-anticoagulated patients had at least one test with INR > 5. The control group of 49 patients had INR results strictly within therapeutic range. A total of 3,683 INR determinations were made in 512 patients. Seventy-seven tests had an INR > 5 (a 2% overall incidence of high-INR). In the group of 55 INR < 5 patients, 31% had more than one INR determination > 5 during follow-up. Multivariate analysis identified four variables as independent predictors of over-anticoagulation: artificial heart valve, poor treatment compliance, addition of potentially interactive new drugs, and illness in the last month. The high-INR group patients had more bleeding episodes (21.8 vs 4.08%; p = 0.008), one of which was major. The incidence of excessive oral anticoagulation in our outpatient population was similar to that reported in other studies. Patients with INR > 5 had more total bleeding complications, mostly minor. It is recommended to proceed carefully with oral anticoagulant therapy in patients with an artificial heart valve, suspected poor treatment compliance, addition of potentially interactive new drugs, and illness in the last month.
    Revista Espa de Cardiologia 01/2003; 56(1):65-72. · 3.20 Impact Factor
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    ABSTRACT: Introducción y objetivos. Existe un amplio consenso sobre la utilización de dicumarínicos en pacientes con fibrilación auricular para prevenir eventos tromboembólicos, aunque su uso real es inadecuado. Nuestro objetivo es determinar y analizar su utilización en pacientes con fibrilación auricular al alta hospitalaria. Pacientes y método. Entre enero y julio de 2000 se estudió retrospectivamente a 501 pacientes consecutivos con el diagnóstico de fibrilación auricular. Se evaluó si recibieron o no anticoagulación oral. Resultados. Se identificó a 482 pacientes que tenían asociado al menos un factor de riesgo tromboembólico, los cuales constituyeron el grupo de pacientes a estudio. La edad media fue de 79,3 años y el 33,3% eran varones. El 46,5% de la muestra fue dada de alta con dicumarínicos y el 36,3% con antiagregantes. El 22,7% de la población presentaba contraindicación para recibir dicumarínicos. El 61,7% de los pacientes sin contraindicación para anticoagulación recibieron tratamiento con acenocumarol. En el análisis multivariado, los factores predictores de mayor probabilidad de recibir tratamiento anticoagulante fueron: valvulopatía mitral reumática, accidente cerebrovascular, embolia periférica, aurícula izquierda dilatada. La edad superior a 75 años se relacionaba con una menor probabilidad de recibir tratamiento con dicumarínicos. Conclusiones. El tratamiento anticoagulante oral se administró en una insuficiente proporción de pacientes con fibrilación auricular, sin contraindicaciones para recibir dicha terapia, que fueron dados de alta de un hospital de segundo nivel. La presencia de valvulopatía mitral reumática, accidente cerebrovascular, embolia periférica y aurícula izquierda dilatada es condición para un mayor uso de anticoagulación. La edad mayor de 75 años se relaciona con un menor uso.
    Revista Espa de Cardiologia 01/2003; · 3.20 Impact Factor
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    ABSTRACT: Background Few studies have attempted to investigate the clinical course or identify factors responsible for excessive anticoagulation in patients with heart disease. Objectives To determine the incidence of excessive anticoagulation in outpatients with heart disease treated with acenocoumarol, analyze the factors related with over-anticoagulation, and identify bleeding complications. Patients and method This 7-month prospective observational study included consecutive outpatients anticoagulated with acenocoumarol. They were seen in an anticoagulation unit. The high INR group of 55 over-anticoagulated patients had at least one test with INR > 5. The control group of 49 patients had INR results strictly within therapeutic range. Results A total of 3,683 INR determinations were made in 512 patients. Seventy-seven tests had an INR > 5 (a 2% overall incidence of high-INR). In the group of 55 INR < 5 patients, 31% had more than one INR determination > 5 during follow-up. Multivariate analysis identified four variables as independent predictors of over-anticoagulation: artificial heart valve, poor treatment compliance, addition of potentially interactive new drugs, and illness in the last month. The high-INR group patients had more bleeding episodes (21.8 vs 4.08%; p = 0.008), one of which was major. Conclusion The incidence of excessive oral anticoagulation in our outpatient population was similar to that reported in other studies. Patients with INR > 5 had more total bleeding complications, mostly minor. It is recommended to proceed carefully with oral anticoagulant therapy in patients with an artificial heart valve, suspected poor treatment compliance, addition of potentially interactive new drugs, and illness in the last month.
    Revista Espa de Cardiologia 01/2003; 56(1):65-72. · 3.20 Impact Factor