Science and Innovations in MedicineScience and Innovations in Medicine2500-13882618-754XFSBEI of Higher Education SamSMU of Ministry of Health of the Russian Federation6505710.35693/2500-1388-2021-6-4-50-54Research ArticleProblems of adherence to treatment with oral anticoagulants in elderly patients with atrial fibrillation in the Kyrgyz RepublicBaziraKanat kyzy<p>postgraduate student of the Department of the hospital therapy, occupational pathology with a course of hematology</p>s.480077@mail.ruhttps://orcid.org/0000-0002-1424-4052Kyrgyz State Medical Academy named after I. K. Akhunbayev151220216450541204202124092021Copyright © 2021, Bazira K.k.2021<p><strong>Objectives</strong> assessment of adherence to treatment in elderly patients with nonvalvular atrial fibrillation who were prescribed anticoagulant therapy with vitamin K antagonist, warfarin, and a new oral anticoagulant rivaroxaban.</p>
<p><strong>Material and methods.</strong> During the study, 322 patients with atrial fibrillation of nonvalvular etiology were observed. Depending on the type of anticoagulant taken, the patients were divided into 2 groups: the first group included 253 (78.6%) people who took warfarin, the second group 69 (21.4%) people, who were prescribed a new oral anticoagulant rivaroxaban.</p>
<p><strong>Results.</strong> By the end of the one-year follow-up from the start of anticoagulant treatment, only 8.7% of patients in the first group followed the doctor's prescription; the second group had 59.4% of adherent patients. The vast majority of patients refused warfarin therapy due to the inability to control INR. In the case of the appointment of rivaroxaban, the reason for the refusal to take was the high cost of the drugs.</p>
<p><strong>Conclusion.</strong> Effective prevention of thromboembolic complications in atrial fibrillation requires the development of appropriate measures to improve adherence to treatment.</p>geriatricselderly peopleatrial fibrillationanticoagulant therapywarfarinгериатрияпожилые людифибрилляция предсердийантикоагулянтная терапияварфарин[Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2020;ehaa612. doi: 10.1093/eurheartj/ehaa612][Lippi G, Sanchis-Gomar F, Cervellin G. Global epidemiology of atrial fibrillation: An increasing epidemic and public health challenge. Int J Stroke. 2019;0(0):1-5. doi: 10.1177/1747493019897870][Kirchhof P, Benussi S, Kotecha D, et al. Esc guidelines for the management of atrial fibrillation developed in collaboration with EACTS. EP Europace. 2016;2016:1609-78. doi.org/10.1093/europace/euw295][World Health Organization. Adherence to long-term therapies. Evidence for action. World Health Organization. Geneva: Word Health Organization 2003. Available.from: http://www.who.int/chp/knowledge/publications/adherence_report/en/][Sofa DA, Hadyana S, Keri L, Rizky A. Medication adherence contributes to an improved quality of life in type 2 diabetes mellitus patients: A cross-sectional study. Diabetes Ther. 2016;7:755-64. doi: 10.1007/s13300-016-0203-x][Sulimov VA, Napalkov DA, Sokolova AA, et al. Anticoagulant therapy in everyday clinical practice: data of the retrospective cross-sectional study. Rational Pharmacotherapy in Cardiology. 2015;11(2):116-123. (In Russ.). [Сулимов В.А., Напалков Д.А., Соколова А.А. и др. Антикоагулянтная терапия в реальной клинической практике: данные ретроспективного одномоментного исследования. Рациональная фармакотерапия в кардиологии. 2015;11(2):116-23]. doi: 10.20996/1819-6446-2015-11-2-116-123][Mayet AY. Patient adherence to warfarin therapy and its impact on anticoagulation control. Saudi Pharm J. 2016;24:29-34. doi: 10.1016/j.jsps.2015.02.005][Granger CB, Alexander JH, John JV, et. al. ARISTOTLE Committees and Investiga-tors. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981-992. doi: 10.1056/NEJMoa1107039][Ciurus T, Cichocka-Radwan A, Lelonek M. Factors affecting the quality of anticoagulation with warfarin: experience of one cardiac centre. Kardiochir Torakochirurgia Pol. 2015;12(4):334-340. doi: 10.5114/kitp.2015.56784][Bazira KK, Musakeev AO, Kinderbaeva NK, et al. Analysis of antithrombotic therapy in the elderly in medical clinical practice of family medicine centers of the Kyrgyz Republic.J. Thrombosis, hemostasis and rheology. 2021;1:40-47. (In Russ.). [Канат кызы Базира, Мусакеев А.О., Киндербаева Н.К. и др. Анализ антитромботической терапии у пожилых людей во врачебной клинической практике центров семейной медицины Кыргызской Республики. Тромбоз, гемостаз и реология. 2021;1:40-47]. doi: org/10.25555/THR.2021.0960][McMurray JJ, Ezekowitz JA, Lewis BS, et al. Left ventricular systolic dysfunction, heart failure, and the risk of stroke and systemic embolism in patients with atrial fibrillation: insights from the ARISTOTLE trial. Circulation Heart Failure. 2013;6(3):451-60. doi: 10.1161/CIRCHEARTFAILURE. 112.000143][Kirchhof P, Benussi S, Kotecha D, et al. ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893-2962. doi: 10.1093/eurheartj/ehw210][Martins MA, Costa JM, Mambrini JV, et al. Health literacy and warfarin therapy at two anticoagulation clinics in Brazil. Heart. 2017;103(14):1089-95. doi: 10.1136/heartjnl-2016-310699][Rodriguez RA, Carrier M, Wells PS. Non adherence to new oral anticoagulants: a reason for concern during long-term anticoagulation? Thromb Haemost. 2013;11(390):394. doi: 10.1111/jth.12086][O'Brien EC. Reasons for Warfarin Discontinuation in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Am Heart J. 2014;168(4):487-494. doi: 10.1016/j.ahj.2014.07.002][Raparelli V, Proietti M, Cangemi R, et al. Adherence to oral anticoagulant therapy in patients with atrial fibrillation. Focus on non-vitamin K antagonist oral anticoagulants. Thromb Haemost. 2017;117:209-218. doi: 10.1160/TH16-10-0757][Patel SI, Cherington C, Scherber R, et al. Assessment of Patient Adherence to Direct Oral Anticoagulant vs Warfarin Therapy. Circulation. Cardiovascular Quality and Outcomes. 2017;117(1):7-15. doi: 10.7556/ jaoa.2017.002][Barrios V, Escobar C, Prieto L, et al. Anticoagulation Control in Patients With Nonvalvular Atrial Fibrillation Attended at Primary Care Centers in Spain: The PAULA Study. Revista Española de Cardiología (English ed.). 2015;68(9):769-76. doi: 10.1016/j.rec.2015.04.017][Camm AJ, Amarenco P, Haas S, et al. XANTUS: a real-world, prospective, observational study of patients treated with rivaroxaban for stroke prevention in atrial fibrillation. Eur Heart J.2016;37(14):1145-53. doi: 10.1093/eurheartj/ehv466][Khruslov MV, Karpenko MA, Vavilova TV, Ponomareva IV. Compliance to antithrombotic therapy in elderly and senile patients with atrial fibrillation. Thrombosis, hemostasis and rheology. 2019;(3):59-63. (In Russ.). [Хруслов М.В., Карпенко М.А., Вавилова Т.В., Пономарева И.В. Копмлаентность к антитромботической терапии у пациентов пожилого и старческого возраста с фибрилляцией предсердий. Тромбоз, гемостаз и реология. 2019;(3):59-63]. doi: 10.25555/THR.2019.3.0891][Pugh D, Pugh J, Gillian E. Mead Attitudes of Physicians Regarding Anticoagulation for Atrial Fibrillation: A Systematic Review. Age Ageing. 2011;40(6):675-683. doi: 10.1093/ageing/afr097][Tindalsky V. Anticoagulant therapy innovations in ensuring for effectiveness and safety. The Lechaschy Vrach Journal. 2020;23(11):60-63. (In Russ.). [Тиндальский В. Инновации антикоагулянтной терапии в обеспечении ее эффективности и безопасности. Лечащий врач. 2020;23(11):60-63].]