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Rev Esp Cardiol (Engl Ed). 2015 Sep;68(9):769-76. doi: 10.1016/j.rec.2015.04.017. Epub 2015 Jul 11.

Anticoagulation Control in Patients With Nonvalvular Atrial Fibrillation Attended at Primary Care Centers in Spain: The PAULA Study.

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Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain. Electronic address:
Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
Bioestadística Médica, Universidad Católica San Antonio de Murcia (UCAM), Murcia, Spain.
Departamento Médico, Bayer Hispania S.L., Barcelona, Spain.
Centro de Salud Casar de Cáceres, Casar de Cáceres, Cáceres, Spain.
Centro de Salud Jazmín, Área 4 de Atención Primaria, Madrid, Spain.
Unidad de Hospitalización Polivalente, Hospital de Alta Resolución El Toyo, Hospital de Poniente El Ejido, Almería, Spain.



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.


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%).


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.


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.


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

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