O.S. Sychov, A.O. Borodai, E.S. Borodai, T.V. Getman, S.V. Fedkiv, A.Yu. Rybak.Adherence and control of long-term anticoagulation therapy in patients with non-valvular atrial fibrillation and its possible relation to silent cerebral infarctions

Material and methods. We examined 135 patients with non valvular AF. SCI were detected in 31.1 % of patients, and in total superficial infarctions were detected in 9.6 %, SCI ≥ 15 mm in 7.4 % of patients and basal SCI in 21.8 %.
Results. The results of univariate analysis showed that low left atrial appendage velocity < 30 cm/s was significantly associated with both superficial and SCI ≥ 15 mm, Р=0.01 and 0.007, respectively. Basal SCI were significantly associated with age ≥ 65 years and creatinine clearance < 90 ml/min. At the time of the study only 14.5 % of patients had international normalized ratio (INR) 2–3. Results of the survey showed that 43.9 % of respondents didn’t know anything about warfarin. Only 42.2 % used warfarin and 37.8 % didn’t use neither anticoagulants, nor aspirin. We found that only 17.2 % of respondents measured INR regularly, 54.3 % patients did not know what is INR. Moreover, among patients on warfarin 68.9 % did nothing if their INR was unsatisfactory. There was significant inverse association between the use of warfarin > 3 and INR 2–3 at the time of the study and superficial P=0.03, χ2=4.9 and basal SCI P=0.02, χ2=5.3.
Conclusions. Silent cerebral infarctions are not uncommon in patients with AF. Large and superficial SCI in the absence of atherosclerosis of carotid and/or large brain arteries commonly have embolic source. Patients with AF have inadequate knowledge about anticoagulants, and those on warfarin have inadequate adherence and control of anticoagulation. This kind of inadequacy was associated with SCI. Further implementation of interventions that have been shown to improve anticoagulation control are necessary for patients with AF.

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