Background: Atrial fibrillation (AF) is the most frequent arrhythmia in clinical practice and is the strongest independent risk factor for stroke. Approximately 50% of all cardiac and systemic emboli occur in individuals with AF.
Objective: The aim of this work is to determine the use of oral antithrombotic therapy for treatment of patient with atrial fibrillation in Kalubia government, Egypt.
Patients and methods: These present cross sectional analytic study was conducted on 200 AF patients and were eligible for antithrombotic therapy. All patients were subjected to full history taken with emphasis on admission details, thromboembolic and hemorrhagic complications, risk factors, also clinical examinations, investigations including prothrombin time, INR ,resting ECG, and trans- thoracic echocardiography data were collected. The patients were divided into two groups, Group A: patients received oral anticoagulation regularly, and Group B: patients not received oral anticoagulation. Group A subdivided into subgroup A1 {controlled patients with normal INR level (2-3)}, and subgroup A2 (patients with uncontrolled INR).
Results: The present study included 200 patients, 83 (41.5%) females and 117 (58.5%) males, their age range from 20 to 87 years old. One hundred and eighty six (93%)of patients with chronic (permanent) AF, 14(7%) with paroxysmal recurrent AF, Forty nine (24.5%) patients presented by rapid AF, and only 4 patients (2.5%) presented by slow AF .The commonest causes of AF in our study was IHD included 117patients (58.5%) ; hypertension found in80 patients (40%), while rheumatic heart disease presented in 78 (39%) of cases, and finally 54patients (27%) with heart failure. Seventy six patients (38%) received oral anticoagulant, 36.8% of them with controlled INR, and most of them with prosthetic valves (92 %).Thromboembolic complications were developed in 9 patients(11.7% )all of them in group A2 versus 39 patients(31.4%)in group B. The estimated bleeding complications in patients taking warfarin developed in 10 patients (13.9%),2 patients (3.1%) of them had intracranial hemorrhage.
Conclusion: Only 38% of patients receive oral anticoagulation regularly, 36.8% of them were properly anticoagulated. Prosthetic valves, rheumatic heart disease, associated with high rate of warfarin use in our study. Intracranial hemorrhages developed in 3.1% with anticoagulated patients, and thromboembolic complications in patients not anticoagulated were31.4%.
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