Prevalencia de efectos adversos y eficacia de la terapia antitrombótica con dabigatran frente a Warfarina en pacientes con fibrilación auricular no valvular en el HTMC durante el periodo enero 2014 - enero 2018.

Abstract

The universe consisted of 500 patients with a diagnosis of atrial fibrillation. The data collection instrument was through the AS400 system of the IESS, in which we collected the information from the patient's medical records and stored in Microsoft Excel. A sample was obtained, according to the inclusion criteria, giving a total of 209 patients, divided into two groups, the first of 106 patients medicated with warfarin and the second of 103 patients who were medicated with dabigatran. Results: The result of the thromboembolics and hemorrhagics risks assessments were obtained, from the scales CHADS2VASC and HAS BLED, respectively. The patients presented the same comorbidities, there was no statistically significant difference between the different age and gender groups, neither for tobacco p: 0.06, obesity p: 0.12, AH p: 0.6, DM p: 0.6, previous stroke p: 0.06, HA p: 0.3. On the contrary, there was a statistically significant difference for alcoholism p: 0.0002, there is probably greater exposure to this cardiovascular risk factor in one of the groups; and, for heart failure 0, 0002, these would indicate a greater presence of heart failure in one of the groups. The CHADSVASC score gave us a p value of 0.01, statistically significant. We can interpret that one group, those medicated with warfarin, have a higher thrombogenic risk because the greater percentage of patients manage infratherapeutic ranges of INR. The HAS BLED score gave us a p-value of 0.13, not statistically significant, both groups had the same hemorrhagic risk. The effectiveness of warfarin was assessed based on the INR values, where most of these patients were in the INR in infra-therapeutic and supra-therapeutic range, which could be due to poor anticoagulant management or not following the medical prescription. In none of the patients with dabigatran the INR was assessed because this medication does not prolong the coagulation times, this is measured according to the time of diluted thrombin, which was not assessed in these patients. Regarding the major bleeding p value: 0.002, lower bleeding p value: 0.0003 and hemorrhagic ECV p value: 0.05 were found to be statistically significant. Conclusion: It was concluded that both groups presented the same probability of presenting hemorrhagic events by means of the HAS BLED score, however, p statistically significant values for the different types of bleeding show that there is a higher prevalence of bleeding in one group than in another. In our study it was determined that patients medicated with warfarin had a higher prevalence of bleeding during the 4 years of the study, unlike the group of patients medicated with dabigatran.