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Rotkreuz/Switzerland, October 6, 2009

The need to improve antithrombotic management

Significant undertreatment in patients with atrial fibrillation

A new consensus article developed by a multidisciplinary expert group was published recently in the Journal of Thrombosis and Haemostasis. The experts recommend improvements in the management of anticoagulant treatment in patients with atrial fibrillation (AF)¹ and assumed that the main reason for undertreatment is an excessive fear of major bleeding. The group emphasized the importance of oral anticoagulation therapy, e.g. for stroke prevention, and that a risk-adjustment with control of INR, e. g. using point-of-care coagulometers, decreases mortality. Better communication of the benefits of stroke prevention, that outweigh the risk of bleeding, is considered to be essential in improving guideline adherence.

The prevalence of AF is increasing worldwide due to an aging population. Over 6 million European Union citizens have paroxysmal or persistent AF, being at higher risk of stroke and increased mortality. Anticoagulant treatment is highly effective in reducing the risk of stroke in these patients. According to international guidelines, such as the joint guidelines of the American College of Cardiology (ACC), the American Heart Association (AHA), and the European Society of Cardiology (ESC), about 60 to 70% of AF patients should receive vitamin K antagonists (VKAs). There is evidence that the benefits of risk-adjusted oral anticoagulation outweigh the risk of bleeding in AF patients. However, there is still significant undertreatment, mainly due to the underestimation of the risk of stroke and overestimation of the risk of bleeding under anticoagulant therapy. “Physicians should first evaluate stroke risk and bleeding risk in a given patient. Then risks and benefits of oral anticoagulation therapy should be discussed.”, said Marcel Levi, chairman of the International Self-Monitoring Association for oral Anticoagulation (ISMAA).

In their consensus paper, cardiologists, haematologists, and laboratory and primary-care physicians with specific expertise from Europe and the U.S. highlighted the value of international practice guidelines, which provide helpful guidance on how to manage oral anticoagulation therapy in patients with AF.1 Since undercoagulated patients with AF are significantly more likely to have a stroke than those maintained within the recommended INR range, dedicated monitoring of the INR values is important.

The use of point-of-care coagulometers can reduce complication rates and mortality

Traditionally, INR testing is performed in different ways: ‘Usual’ care by general practitioners, specialists or anticoagulation clinics; patient self-testing (PST); and patient self-management (PSM). In the usual care option, patients are cared for by their personal physician. A number of studies showed that PSM of oral anticoagulation using point-of-care coagulometers (e.g. CoaguChek®)* improved the quality of anticoagulation. Thus, complication rates and mortality was reduced compared to usual care. In addition, PSM was at least as good as, or even slightly better, than management in specialised anticoagulation clinics.

Accordingly, the current guidelines recommend PSM and PST for the management of patients with AF. Better INR control by PSM using point-of-care coagulometers may help to improve the outcomes in the increasing number of patients with AF.

*CoaguChek®, Roche Diagnostics, Basel, Switzerland. www.coaguchek.com

References
1 Levi M et al. Improving antithrombotic management in patients with atrial fibrillation: current status and perspectives. Semin Thromb Hemost 2009;35:527-542.

About Roche

Headquartered in Basel, Switzerland, Roche is one of the world’s leading research-focused healthcare groups in the fields of pharmaceuticals and diagnostics. As the world’s biggest biotech company and an innovator of products and services for the early detection, prevention, diagnosis and treatment of diseases, the Group contributes on a broad range of fronts to improving people’s health and quality of life. Roche is the world leader in in-vitro diagnostics and drugs for cancer and transplantation, and is a market leader in virology. It is also active in other major therapeutic areas such as autoimmune diseases, inflammatory and metabolic disorders and diseases of the central nervous system. In 2008 sales by the Pharmaceuticals Division totalled 36.0 billion Swiss francs, and the Diagnostics Division posted sales of  9.7 billion francs. Roche has R&D agreements and strategic  alliances with numerous partners, including majority ownership interests in Genentech and Chugai, and invested nearly 9 billion Swiss francs in R&D in 2008. Worldwide, the Group employs about 80,000 people. Additional information is available on the Internet at www.roche.com.

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