Letter to the Editor
Quality of life in patients with oral anticoagulation therapy
Calidad de vida en pacientes con tratamiento anticoagulante oral
Juan José Criado-Álvareza,b,
, Jaime González Gonzálezb,c, Silvia Martín Garcíaa, Carmen Romo Barrientosd
Corresponding author
a Consultorio Médico de San Bartolomé de las Abiertas, Centro de Salud de La Pueblanueva, Gerencia de Atención Integrada de Talavera de la Reina, Servicio de Salud de Castilla-La Mancha (SESCAM), Talavera de la Reina, Toledo, Spain
b Facultad de Terapia Ocupacional, Logopedia y Enfermería, Universidad de Castilla-La Mancha, Talavera de la Reina, Toledo, Spain
c Consultorio Médico de Otero, Centro de Salud de Santa Olalla, Gerencia de Atención Integrada de Talavera de la Reina, Servicio de Salud de Castilla-La Mancha (SESCAM), Talavera de la Reina, Toledo, Spain
d Servicio de Salud Mental, Gerencia de Atención Integrada de Talavera de la Reina, Servicio de Salud de Castilla-La Mancha (SESCAM), Talavera de la Reina, Toledo, Spain
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"aff0005" ] 1 => array:3 [ "entidad" => "Facultad de Terapia Ocupacional, Logopedia y Enfermería, Universidad de Castilla-La Mancha, Talavera de la Reina, Toledo, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Consultorio Médico de Otero, Centro de Salud de Santa Olalla, Gerencia de Atención Integrada de Talavera de la Reina, Servicio de Salud de Castilla-La Mancha (SESCAM), Talavera de la Reina, Toledo, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Salud Mental, Gerencia de Atención Integrada de Talavera de la Reina, Servicio de Salud de Castilla-La Mancha (SESCAM), Talavera de la Reina, Toledo, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Calidad de vida en pacientes con tratamiento anticoagulante oral" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">According to the work published by Marco et al.,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> the creation of direct oral anticoagulants seems to be close to perfection. These new drugs offer new therapeutic possibilities that cannot be overlooked, calling for a paradigm shift in terms of oral anticoagulation, for a number of reasons (monitoring, interactions).<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,3</span></a> All this might suggest that patients’ quality of life (QOL) would improve thanks to these new drugs, but we first need to know the QOL they have now with their current drugs.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We have conducted a cross-sectional study in order to establish the QOL regarding the oral anticoagulant treatment administered in the township of San Bartolome de las Abiertas (Toledo) (population<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>512 inhabitants, year 2013). We have included all of the patients who are receiving treatment (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>22) since there are no subjects affected by immobilization, serious diseases or cognitive impairment, and all of them agreed to participate. This study group has been matched by age, gender, and working capacity (active/retired) with a control group from the same population. In both groups, a record has been made to establish the number of drugs administered (excluding the oral anticoagulation treatment), their capacity according to the Barthel Index, and the QOL, following the <span class="elsevierStyleItalic">EuroQol-5D</span> questionnaire (EQ-5D) and its visual analogue scale (VAE), all managed by the same observer. In addition, the QOL of subjects for the study group pertaining to the oral anticoagulation treatment has been assessed according to the <span class="elsevierStyleItalic">Sawicki Questionnaire for Patients Receiving Oral Anticoagulation Treatment</span> (QPOA). The QPOA is a questionnaire consisting of 32 questions grouped into 5 levels (satisfaction, self-efficacy, stress, daily limitations and alterations in their social lives), with 6 possible answers in a scale of Lickert (1–6). The value of each level is the measure of its constituent questions. The QPOA has been validated and adapted to Spanish.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4,5</span></a> The questionnaire has been hetero-managed by a sole administrator. In addition to indicating the treatment, dicoumarinic anticoagulation average doses and the last two-month period INR were measured.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Our 44 patients took oral dicoumarinic anticoagulants (acenocoumarol, presented in doses of 1 and 4<span class="elsevierStyleHsp" style=""></span>mg), their average age was 76 years (range 52–90), 59% of them were women (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>26), the average drugs consumed were 6.4 (range 1–12), their average Barthel Index was 92.39 (range 35–100, average: 100), with a standardised average EQ-5D of 0.83 and an average VAE of 76.68 (range 62–90), without statistically significant differences (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.05) in all its variables between the control group and study group. Subjects from the study group were administered weekly an average of 12.4<span class="elsevierStyleHsp" style=""></span>mg with a 2.58 standard INR (range 1.9–3.75). Only 2 patients were outside of the therapeutic range for the administration of anticoagulants. Anticoagulation treatment is most frequently indicated in patients suffering from atrial fibrillation (50%), followed by mitral valve disease with atrial fibrillation (31.8%). According to the QPOA, our patients were partially satisfied (2.51), with few limitations in their daily lives (2.72), and very few alterations in their social lives (1.51). They had a high self-efficacy or ability to be in control (4.03). Our results are in agreement with the results shown by other studies (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Dicoumarinic anticoagulants did not affect the patients’ QOL significantly, just as in other similar studies,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> despite the fact that their average age exceeded that of subjects in other studies, and that they were polymedicated patients taking 6.4 drugs (excluding dicoumarinic anticoagulants). The fact that there was a control group and that the subjects from this group had an average QOL, measured according to the EQ-5D test or the Barthel Index, that was similar in both groups, rules out the idea that our study sample had a worse QOL. One of the limitations of the study is its small sample size (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>22), but it represents 100% of the population treated with oral anticoagulants, representing 4.3% of the population, or that 36% of patients are actively working (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8).</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patients who participated in this study benefitted from the agility and accessibility to the health system of their townships, with a good problem-solving rate, reflected by the patients’ good INR control, without waiting lists and with closer contact. In some cases, a change of treatment could be suggested, but in view of the results, it does not seem to be necessary due to the closely followed attention that patients receive and the awareness of therapeutic compliance generated by monitoring INR figures. Therefore, new oral anticoagulants may coexist with dicoumarinic anticoagulants depending on the clinical and social situation of patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Criado-Álvarez JJ, González González J, Martín García S, Romo Barrientos C. Calidad de vida en pacientes con tratamiento anticoagulante oral. Med Clin (Barc). 2015;144:46–47.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Part of this work will be presented as an oral communication in the V Congreso Regional de Castilla-La Mancha de SEMERGEN (Talavera de la Reina, 7 and 8 March 2014).</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Study \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Age (years) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Sample \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Questionnaire QPOA</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Satisfaction \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Self-efficacy \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Stress \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Daily limitations \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Social life alterations \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Criado-Alvarez, 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76.2 (9.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.51 (0.48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.03 (0.86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.72 (0.69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.51 (0.62) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.69 (0.33) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Davila Blazquez et al., 2012<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69.0 (10.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.78 (0.75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.43 (0.59) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.45 (0.72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.51 (0.70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.05 (0.64) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Gonzalez Lopez et al., 2012<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">>64: 71.7%<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">120 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.90 (0.80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.50 (1.10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.90 (1.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.10 (0.90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.70 (0.80) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yanes Baonza et al., 2005<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">65.0 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">225 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.50 (0.63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.83 (1.02) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.47 (0.84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.77 (0.89) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.34 (0.61) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Gadisseur et al., 2004<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">163 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.71 (0.64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.03 (0.88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.11 (0.91) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.05 (0.81) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.46 (0.62) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sawicki, 1999<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55.1 (11.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">179 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.84 (1.41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.70 (0.98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.19 (1.04) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.05 (0.75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.97 (1.11) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab886713.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Personal communication.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Results from the Sawicki questionnaire for patients receiving oral anticoagulation treatment, either primary care or outpatient.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nuevas perspectivas clínicas en el uso de los anticoagulantes orales directos" "autores" => array:1 [ 0 => 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