title: Quality of Vitamin K Antagonist Anticoagulation in Spain: Prevalence of Poor Control and Associated Factors.
abstract: OBJECTIVE
  To study the prevalence of poorly controlled vitamin K antagonist anticoagulation in Spain in patients with nonvalvular atrial fibrillation, and to identify associated factors.
  
  
  METHODS
  We studied 1056 consecutive patients seen at 120 cardiology clinics in Spain between November 2013 and March 2014. We analyzed the international normalized ratio from the 6 months prior to the patient's visit, calculating the prevalence of poorly controlled anticoagulation, defined as < 65% time in therapeutic range using the Rosendaal method.
  
  
  RESULTS
  Mean age was 73.6 years (standard deviation, 9.8 years); women accounted for 42% of patients. The prevalence of poorly controlled anticoagulation was 47.3%. Mean time in therapeutic range was 63.8% (25.9%). The following factors were independently associated with poorly controlled anticoagulation: kidney disease (odds ratio = 1.53; 95% confidence interval, 1.08-2.18; P = .018), routine nonsteroidal anti-inflammatory drugs (odds ratio = 1.79; 95% confidence interval, 1.20-2.79; P = .004), antiplatelet therapy (odds ratio = 2.16; 95% confidence interval, 1.49-3.12; P < .0001) and absence of angiotensin receptor blockers (odds ratio = 1.39; 95% confidence interval, 1.08-1.79; P = .011).
  
  
  CONCLUSIONS
  There is a high prevalence of poorly controlled vitamin K antagonist anticoagulation in Spain. Factors associated with poor control are kidney disease, routine nonsteroidal anti-inflammatory drugs, antiplatelet use, and absence of angiotensin receptor blockers.
authors: Agencia de Investigación, Sociedad Española de Cardiología, Madrid, Spain; Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain. Electronic address: manuelp.anguita.sspa@juntadeandalucia.es.
authors: Manuel
authors: M
authors: Anguita Sánchez
authors: Agencia de Investigación, Sociedad Española de Cardiología, Madrid, Spain; Servicio de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
authors: Vicente
authors: V
authors: Bertomeu Martínez
authors: Agencia de Investigación, Sociedad Española de Cardiología, Madrid, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors: Ángel
authors: Á
authors: Cequier Fillat
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications*; D001777:Blood Coagulation; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K
keywords: Antagonistas de la vitamina K; Anticoagulantes orales; Fibrilación auricular no valvular; Método de Rosendaal; Nonvalvular atrial fibrillation; Oral anticoagulants; Rosendaal method; Vitamin K antagonists