Prof. Dr. J. Ansell pointed out in his talk "Quality of oral anticoagulation management and various management strategies in patients with atrial fibrillation (AF)": The use of VKAs is increasing commensurate with the aging population and the rise in the frequency of atrial fibrillation.
Although the fraction of patients with AF treated with anticoagulants is increasing, there is still world-wide under (or non) treatment of AF.
Under treatment or non-treatment of AF is attributed to physician concern about the risk of bleeding in elderly patients and the problems of monitoring and managing therapy.AC management can be facilitated and made easy by the use of specialized AC clinics or patient self-monitoring at home.
Prof. Dr. Heinz Völler, Rudersdorf/Germany presented a study referring to patients with atrial fibrillation (AF), who manage their INR by themselves. The results are encouraging, as the rates of bleeding and/or thrombosis are lower than in the routine care group. He pointed out that long-term anticoagulation therapy in the elderly is easy to manage, if the patient is well trained.
Efficacy and safety of vitamin K antagonists in elderly patients with atrial fibrillation (AF) are problematical but there are good strategies in the treatment. Challanges of Warfarin use are: Variable dose response - individualized dosing, interactions with medication and diet, narrow therapeutic window, need for frequent monitoring and long half-life. This explained Prof. Dr. Elaine Hylek, Boston/USA, in her talk.In his talk “The chronic use of anticoagulant agents: The patient’s perspective” described Christian Schaefer, Ratingen/Germany, that patients have potential difficulties, worries, expectations and preferences in the therapy with anticoagulants and anticoagulated patients would like to receive information and support. He comes to the conclusion that "anticoagulated patients need own responsibility for their therapy with anticoagulants and for their health and active, informed anticoagulated patients are natural partners for GP'S in managing anticoagulation therapy efficiently".
Prof. Dr. Marcel Levi, Amsterdam/The Netherlands, explained in his talk that there is still a discrepancy between the evidence-based guidelines and real clinical practice in the safety of oral anticoagulant treatment inpatients with atrial fibrillation.
Picture above (from left to right): Prof. Dr. Heinz Völler, Christian Schaefer, Prof. Dr. Jack Ansell, Prof. Dr. Elaine Hylek, Prof. Dr. Marcel Levi
Christian Schaefer (Vienna, Sept 3rd, 2007)