Oral anticoagulation in patients with atrial fibrillation and medical non-neoplastic disease in a terminal stage

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• 作者：Jesús Díez-Manglano ; Máximo Bernabeu-Wittel…
• 关键词：Atrial fibrillation ; Oral anticoagulants ; Calcium channel blockers ; Terminal stage disease ; Survival
• 刊名：Internal and Emergency Medicine
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：12
• 期：1
• 页码：53-61
• 全文大小：
• 刊物主题：Internal Medicine;
• 出版者：Springer Milan
• ISSN：1970-9366
• 卷排序：12

文摘

Many patients with non-neoplastic disease develop atrial fibrillation in advanced stages of their disease. The aim of this study is to determine the factors associated with the use of oral anticoagulants in patients with atrial fibrillation and non-neoplastic medical disease in a terminal stage, and whether their use is associated with a longer survival. Design is prospective, observational, multicentre study. Patients with atrial fibrillation and non-neoplastic disease (severe not reversible organ insufficiency) in a terminal stage were included between February 2009 and September 2010. A 6-month follow-up was carried out. We included 314 patients with a mean (SD) age of 82.6 (7.0) years. Their mean (SD) scores in CHADS2 and ATRIA scales were 3.4 (1.2) and 4.7 (2.0), respectively. Anticoagulants were prescribed to 112 (37.5 %) patients. The use of anticoagulants was associated with age (OR 0.96 95 % CI 0.93–0.99, p = 0.046) and to the Barthel index (OR 1.01 95 % CI 1.00–1.02; p = 0.034). After performing a propensity score matching analysis, 262 patients were included in the survival analysis. After 6 months, 133 (50.8 %) patients were dead. The mortality is higher among patients who are not treated with oral anticoagulants (57.1 vs. 39.4 %; p = 0.006), but it is independently associated only with the Barthel index score (HR 0.99 95 % CI 0.98–1.00; p = 0.039), delirium (HR 1.60, 95 % CI 1.08–2.36; p = 0.018), anorexia (HR 1.58 95 % CI 1.05–2.38; p = 0.027), and with the use of calcium channel blockers (HR 0.50 95 % CI 0.30–0.84; p = 0.009). In patients with atrial fibrillation and non-neoplastic disease in a terminal stage, the use of oral anticoagulants is not independently associated with a higher probability of survival.