Atrial Fibrillation (AF) is associated with an increased risk of stroke and systemic embolism. Several studies have suggested that female AF patients could have a greater risk for stroke. There is ...scarce information about clinical characteristics and use of antithrombotic therapies in Latin American patients with nonvalvular AF.
To describe the gender differences in clinical characteristics, thromboembolic risk, and antithrombotic therapy of patients with nonvalvular AF recruited in Mexico, an upper middle-income country, into the prospective national CARMEN-AF Registry.
A total of 1423 consecutive patients, with at least one thromboembolic risk factor were enrolled in CARMEN-AF Registry during a three-year period (2014–2017). They were categorized according to Gender.
Overall, 48.6% were women, mean age 70 ± 12 years. Diabetes, smoking, alcoholism, non-ischemic cardiomyopathy, coronary artery disease, and obstructive sleep apnea were higher in men. Most women were found with paroxysmal AF (40.6%), and most men with permanent AF (44.0%). No gender differences were found in the use of vitamin K antagonists (VKA) (30.5% in women vs. 28.0% in men). No gender differences were found in the use of direct oral anticoagulants (DOAC) (33.8% women vs 35.4% men).
CARMEN-AF Registry demonstrates that in Mexico, regardless of gender, a large proportion of patients remain undertreated. No gender differences were found in the use of VKA or DOAC.
Documenting the patterns of oral anticoagulation therapy (OAT) is essential to prevent thromboembolic complications of nonvalvular atrial fibrillation (NVAF).
To report the patterns of OAT according ...to age and thromboembolic risk in patients included in CARMEN-AF, a nationwide registry of NVAF in Mexico, an upper middle-income country.
There were 1,423 consecutive patients ≥18 years old and with at least one thromboembolic risk factor enrolled in the CARMEN-AF Registry at their regular clinical visit during a three-year period. They were analyzed according to 1) age, 2) AF type, and 3) CHA
DS
-VASc score.
Overall, 16.4% of patients did not receive antithrombotic treatment, 19.4% received antiplatelet drugs (APD), 29.2% vitamin K antagonists (VKA), and 34.6% direct oral anticoagulants (DOAC). With increasing age, the proportion of subjects treated with VKA decreased significantly from 36.2% in subjects <65 years to 22.5% in those ≥75 years old (
<0.0001). Concomitantly, an increase in both APD and no antithrombotic treatment was observed with increasing age. DOAC were prescribed equally among all age groups (34.2% in <65, 36.0% in 65-74, and 33.9% in ≥75). According to the type of AF, VKA use was more common in patients with permanent AF (32.7%). A lower use of DOAC was observed in high thromboembolic risk subjects (33.6% in CHA
DS
-VASc ≥2) compared with the moderate risk group (41% in CHA
DS
-VASc = 1).
VKA use for NVAF in Mexico decreased in relation to increasing age. The proportion of DOAC therapy was the same in all age groups. Nevertheless, elderly patients with high thromboembolic risk received a suboptimal thromboprophylaxis. These data could help to improve gaps in the implementation of global guidelines.
http://www.clinicaltrials.gov. Unique identifier: NCT02334852.
CARMEN-AF is a nationwide multi-centric registry seeking to bridge the data gap on anticoagulation therapy for NVAF in Mexico.Elderly patients are more prone to receive suboptimal OAT for NVAF.DOAC were less frequently used in high thromboembolic risk patients (CHA
DS
-VASc ≥2).
Resumen OBJETIVOS Comunicar una serie de casos de síndrome de Guillain-Barré y describir las características clínicas de una posible asociación con infección previa por virus Zika. MATERIAL Y MÉTODO ...Estudio descriptivo de serie de casos en el que se recolectaron datos clínicos, bioquímicos y demográficos de los pacientes con síndrome de Guillain-Barré tratados en el Hospital General Acapulco con antecedente reciente de síndrome viral agudo sospechoso de infección por virus Zika, del 24 de julio al 24 de agosto de 2016, con realización de estudio de líquido cefalorraquídeo y comprobación de disociación albúmino-citológica. Se estableció diagnóstico de certeza de síndrome de Guillain-Barré según los criterios de Asbury-Cornblath y Brighton. RESULTADOS Se estudiaron 10 pacientes con síndrome de Guillain-Barré y antecedente reciente de síndrome viral agudo compatible con infección por virus Zika; la edad media de los sujetos en estudio fue de 47.8 años, 4 eran hombres. Los déficits motor y sensitivo sobrevinieron en una mediana de 4.5 y 4.3 días, respectivamente, después del inicio de los síntomas de infección viral. Hubo complicaciones, como neumonía asociada con ventilación mecánica, infección de vías urinarias en tres casos y disautonomía en dos casos. CONCLUSIONES Todos los casos de este brote de síndrome de Guillain-Barré tenían antecedente reciente de infección sospechosa por virus Zika, lo que refuerza la evidencia existente de la asociación entre el síndrome de Guillain-Barré y la infección por virus Zika.
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