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Antiplatelet or Anticoagulant: Do They Have the same Efficacy?. University of Central Florida Deborah Andrews RN, BSN. Purpose. To evaluate antiplatelet versus anticoagulant agents for prevention of thromboembolic stroke in atrial fibrillation patients Anticoagulants:
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Antiplatelet or Anticoagulant:Do They Have the same Efficacy? University of Central Florida Deborah Andrews RN, BSN
Purpose • To evaluate antiplatelet versus anticoagulant agents for prevention of thromboembolic stroke in atrial fibrillation patients • Anticoagulants: • small therapeutic range • Underuse by health care providers • Non-compliance by patients
BackgroundAtrial Fibrillation • Disorganized contractions that disrupt blood flow through the heart • 2.66 Million Americans • 2009 11,555 deaths attributed to AFib • Risk increases with age • 6.4 Billion dollars annually in U.S.
Stroke • AFib increases risk by 5 fold • 159,000 annually attributed to AFib • Ischemia is responsible for 87% • Strokes regardless of cause cost Americans 23 Billion dollars annually • 24% of AFib patients not offered pharmacologic treatment
Anticoagulant Agents • Warfarin reduces stroke by 60% • Inhibits Vitamin K clotting enzymes • Small therapeutic range • Multiple adverse effects • Only oral anticoagulant used in U.S.
Antiplatelet Agents • Aspirin: Up to 20% Stroke reduction • COX inhibitor • Readily available, Inexpensive, Familiar • Adverse effects: GI, Bleeding, toxicity • New Antiplatelets: Clotting Cascade
Research Question Do Antiplatelet Medications Have the Same Efficacy as Anticoagulants for Preventing Thromboembolic Events in Atrial Fibrillation patients?
Relevance to Nursing • Management of Patient Medications • Availability to Patients • Compliance • Less Adverse Risks • Quality of Life for Patients • Need for Education • Lower Healthcare Costs
Methods • Data Bases: • CINAHL Plus • MEDLINE • Cochrane Data Base of Systemic Reviews Google • Search Terms: • Anticoagulant, Antiplatelet • Atrial Fibrillation, Stroke • Prevention, Warfarin, Aspirin, Clopidogrel
Criteria Inclusion Exclusion Duplicate Studies Published prior to 2000 Embolic events From Other Sources Intravenous agents Patients < 60 years Poor Quality • Published: 2000 - 2010 • AFib Patients >60 years • Available in English • Measurable Outcomes • Prevention of Thromboembolic Events • Oral agents • Randomized
Study Characteristics Findings
Synopsis of Findings Hart et al., 2007 & Mant et al., 2007
Synopsis FindingsOAC Bover et al., 2009 & Hart et al. 2007
Total of All Trials, 29,457 Patients 4.8% Stroke Rate Bover et al., 2009, Hart et al. ,2007, & Mant et al., 2007
Time in Therapeutic Range • INR Ranges Varied Study to Study • Average Time in Therapeutic Range 67% - 69% (Meta-Analysis: undetermined) Bover et al., 2009, Hart et al. ,2007, & Mant et al., 2007
Prospective Queries • Is Combination Therapy Better Than Monotherapy for Prevention of Ischemic Stroke? • Are the New Antiplatelet Agents Safer Than Warfarin?