title: Anticoagulation Control in Patients With Nonvalvular Atrial Fibrillation Attended at Primary Care Centers in Spain: The PAULA Study.
abstract: OBJECTIVE
  To determine the current status of anticoagulation control in patients with nonvalvular atrial fibrillation treated with vitamin K antagonists in the primary care setting in Spain.
  
  
  METHODS
  The PAULA study was a multicenter cross-sectional/retrospective observational study conducted throughout Spain. The study included patients with nonvalvular atrial fibrillation who had been receiving vitamin K antagonist therapy during the past year and were attended at primary care centers. International normalized ratio (INR) values over the past 12 months were recorded. The degree of anticoagulation control was defined as the time the patient had remained within the therapeutic range and was determined by both the direct method (poor control < 60%) and by the Rosendaal method (poor control < 65%).
  
  
  RESULTS
  The study assessed 1524 patients (mean age, 77.4 ± 8.7 years; 48.6% women; 64.2% in permanent atrial fibrillation; CHADS2 mean, 2.3 ± 1.2; CHA2DS2-VASc, 3.9 ± 1.5, and HAS-BLED, 1.6 ± 0.9). The mean number of INR readings recorded per patient was 14.4 ± 3.8. A total of 56.9% of patients had adequate INR control according to the direct method and 60.6% according to the Rosendaal method. The multivariate analysis identified the following predictors for poor INR control: female sex, dietary habits potentially affecting anticoagulation with vitamin K antagonists, multidrug therapy, and a history of labile INR.
  
  
  CONCLUSIONS
  Approximately 40% of patients (43.1% by the direct method and 39.4% by the Rosendaal method) with nonvalvular atrial fibrillation who were receiving anticoagulation therapy with vitamin K antagonists in primary care in Spain had poor anticoagulation control during the previous 12 months.
authors.affiliation: Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain. Electronic address: vivencio.barrios@gmail.com.
authors.forename: Vivencio
authors.initials: V
authors.lastname: Barrios
authors.affiliation: Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Escobar
authors.affiliation: Bioestadística Médica, Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Prieto
authors.affiliation: Departamento Médico, Bayer Hispania S.L., Barcelona, Spain.
authors.forename: Genoveva
authors.initials: G
authors.lastname: Osorio
authors.affiliation: Centro de Salud Casar de Cáceres, Casar de Cáceres, Cáceres, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Polo
authors.affiliation: Centro de Salud Jazmín, Área 4 de Atención Primaria, Madrid, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Lobos
authors.affiliation: Unidad de Hospitalización Polivalente, Hospital de Alta Resolución El Toyo, Hospital de Poniente El Ejido, Almería, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Vargas
authors.affiliation: Departamento Médico, Bayer Hispania S.L., Barcelona, Spain.
authors.forename: Nicolás
authors.initials: N
authors.lastname: García
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications*; D001777:Blood Coagulation / Q000187:drug effects*; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D014812:Vitamin K
keywords: Antagonistas de la vitamina K; Control de la razón internacional normalizada; Fibrilación auricular no valvular; International normalized ratio control; Nonvalvular atrial fibrillation; Rosendaal; Vitamin K antagonists