Quality of anticoagulation control among patients with atrial fibrillation: An experience of a tertiary care center in Saudi Arabia

Background: Atrial fibrillation (AF) is the most common chronic rhythm disorder. Patients with AF are at an increased risk of ischemic stroke. Therefore, optimal anticoagulation is essential to reduce the risk of stroke. The aim of this study was to assess the level of anticoagulation control achieved in patients with nonvalvular AF receiving medical care in a tertiary care hospital. Methods: This was a retrospective cohort study in ambulatory care clinics at tertiary care hospital in Saudi Arabia. We included 110 nonvalvular AF patients treated with warfarin for at least 3 months at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between May 1, 2012, and July 31, 2012. Thereafter, international normalized ratio results were collected for 1 year. Anticoagulation control was assessed by calculating time within therapeutic range (TTR) as per the Rosendaal method. Results: The mean age was 64.9 ± 16.5 years; 60.9% were female. The mean TTR was 59%. Almost one third of the patients (32.7%) had poor anticoagulation control; TTR of <50%. Poor anticoagulation control was significantly associated with higher CHADS2 (congestive heart failure, hypertension, age, diabetes, stroke) score (p = 0.043). TTR was not significantly different between men and women. Similarly, TTR was not associated with age or duration of anticoagulation. There was no adequate information to assess the effect of other factors such as diet, compliance, and level of education on anticoagulation. Thirty-one patients (28.2%) had a history of prior stroke. The overall quality of anticoagulation was not significantly different between patients with and without stroke, (TTR was 56.3% and 60.1%, respectively; p = 0.46). Conclusion: Quality of anticoagulation in patients with AF receiving medical care in a tertiary care hospital was suboptimal, with nearly 40% of the time spent outside the therapeutic range. Methods to improve anticoagulation control among patients with AF should be implemented

BLOOD TRANSFUSION REACTION IN EMERGENCY DEPARTMENT

Early detection, rapid cessation of the transfusion, early consultation with the hematologic and ICU departments, and fluid resuscitation are all necessary for the initial management of blood transfusion reactions. It is crucial that doctors stay current with the literature, are knowledgeable of the pathophysiology, early therapy, and hazards of each type of transfusion reaction because blood transfusions can result in major adverse consequences. Immune-mediated transfusion responses frequently result from a mismatch or incompatibility between the recipient and the transfused substance. Monitoring the patient's respiration rate, blood pressure, temperature, and pulse rate is necessary. Abnormal clinical characteristics, such as fever, rashes, or angioedema, should also be constantly evaluated