Predictors for guideline-nonadherence	with antithrombotic therapy in outpatients with	chronic atrial fibrillation: Napovedniki antitrombotične terapije pri ambulantnih bolnikih s kronično atrijsko fibrilacijo, ki odstopa od smernic zdravljenja

Reinhild Bücheler; Christoph  Meisner; Ruth Bösel; Richard  Fux; Christine  Jägle; Lusine Danielyan; Katrin  Schwarz; Christoph  H. Gleiter; Klaus  Mörike

doi:10.18690/actabiomed.11

Avtorji

Reinhild Bücheler University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany;Medical Service of the Public Health Assurance (MDK) in Baden-Württemberg, Lahr, Germany , University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany;Medical Service of the Public Health Assurance (MDK) in Baden-Württemberg, Lahr, Germany Author
Christoph Meisner University Hospital Tübingen, Institute of Medical Information Processing, Tübingen, Germany , University Hospital Tübingen, Institute of Medical Information Processing, Tübingen, Germany Author
Ruth Bösel University Hospital Tübingen, Institute of Medical Information Processing, Tübingen, Germany , University Hospital Tübingen, Institute of Medical Information Processing, Tübingen, Germany Author
Richard Fux University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany , University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany Author
Christine Jägle University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany , University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany; Author
Lusine Danielyan University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany;Medical Service of the Public Health Assurance (MDK) in Baden-Württemberg, Lahr, Germany , University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany Author
Katrin Schwarz University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany , University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany Author
Christoph H. Gleiter University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany;CenTrial GmbH, Tübingen, Germany , University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany;CenTrial GmbH, Tübingen, Germany Author
Klaus Mörike University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany , University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany Author

DOI:

https://doi.org/10.18690/actabiomed.11

Ključne besede:

atrijska fibrilacija, antitrombotično zdravljenje, smernice

Povzetek

Namen: Razlogi za neustreznost antitrombotičnega zdravljenja pri bolnikih z atrijsko fibrilacijo (AF) so dobro znani. Naši cilj je bil določiti kvaliteto antitrombotičnega zdravljenja pri skupini bolnikov s kronično AF in določiti omejitve ustreznosti antitrombotičnega zdravljenja.

Metode: Z multicentričnimi raziskavami smo analizirali podatke o zdravljenju, dejavnikih tveganja za možgansko kap in psihosocialne dejavnike. S pomočjo logistične regresije smo ugotavljali napovedne dejavnike za neustreznost antitrombotičnega zdravljenja, ki odstopa od ustaljenih smernic pri ambulantnih bolnikih s kronično atrijsko fibrilacijo

Rezultati: Od 413 ambulantnih bolnikov s kronično AF, ki so bili napoteni iz ambulant družinskih zdravnikov, je bilo 184 (44,6%) zdravljenih po priporočenih smernicah (American College of Chest Physicians - ACCP 2001). V skupini bolnikov z visokim tveganjem za možgansko kap (n=387), je bilo 178 bolnikov (46,0%) zdravljenih po smernicah. 31 bolnikov z visokim tveganjem je prejelo kumarinsko terapijo, čeprav je bila pri njih prisotna vsaj ena kontraindikacija. Multivariantna analiza je pokazala, da je prisotnost absolutne kontraindikacije za kumarin neodvisni napovednik za zdravljenje, ki odstopa od smernic.

Zaključek: Za izboljšanje priporočenih smernic antitrombotič nega zdravljenja ambulatnega bolnika z AF, je dejavnike tveganja potrebno upoštevati za vsakega bolnika posebej.

Biografije avtorja

Reinhild Bücheler, University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany;Medical Service of the Public Health Assurance (MDK) in Baden-Württemberg, Lahr, Germany, University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany;Medical Service of the Public Health Assurance (MDK) in Baden-Württemberg, Lahr, Germany

Reinhild Bücheler, Tübingen, Nemčija. E-pošta: christoph.gleiter@med.unituebingen.de
Christoph Meisner, University Hospital Tübingen, Institute of Medical Information Processing, Tübingen, Germany, University Hospital Tübingen, Institute of Medical Information Processing, Tübingen, Germany

Christoph Meisner, Tübingen, Nemčija.
Ruth Bösel, University Hospital Tübingen, Institute of Medical Information Processing, Tübingen, Germany, University Hospital Tübingen, Institute of Medical Information Processing, Tübingen, Germany

Ruth Bösel, Tübingen, Nemčija.
Richard Fux, University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany, University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany

Richard Fux, Tübingen, Nemčija.
Christine Jägle, University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany, University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany;

Christine Jägle, Tübingen, Nemčija.
Lusine Danielyan, University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany;Medical Service of the Public Health Assurance (MDK) in Baden-Württemberg, Lahr, Germany, University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany

Lusine Danielyan, Tübingen, Nemčija.
Katrin Schwarz, University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany, University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany

Katrin Schwarz, Tübingen, Nemčija.
Christoph H. Gleiter, University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany;CenTrial GmbH, Tübingen, Germany , University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany;CenTrial GmbH, Tübingen, Germany

Christoph H. Gleiter, Tübingen, Nemčija.
Klaus Mörike, University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany, University Hospital Tübingen, Institute of Pharmacology and Toxicology, Department of Clinical Pharmacology, Tübingen, Germany

Klaus Mörike, Tübingen, Nemčija.

Predictors for guideline-nonadherence with antithrombotic therapy in outpatients with chronic atrial fibrillation

Napovedniki antitrombotične terapije pri ambulantnih bolnikih s kronično atrijsko fibrilacijo, ki odstopa od smernic zdravljenja

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