Characterization of patients with atrial fibrillation not treated with oral anticoagulants

Abstract

Objective. An underuse of oral anticoagulants (OAC) in patients with atrial fibrillation (AF) has been suggested, as only 50% of all patients with AF receive OAC treatment. Whether this is due to contraindications, lack of an indication to treat, or an expression of underuse is sparsely investigated. This study therefore aimed to characterize individuals without OAC treatment in a real-life population of patients with AF. Design. Retrospective cross-sectional study. The medical records were scrutinized in order to identify the type of AF, risk factors for embolism and bleeding, and other factors of importance for OAC treatment. Setting. The municipalities of Skellefteå and Norsjö, northern Sweden. Subjects. A total of 2274 living residents with at least one verified episode of AF on or before December 31, 2010. Main outcome measures. Prevalence of treatment with OAC and documented reasons to withhold OAC treatment. Results. Among all 2274 patients with AF, 1187 (52%) were not treated with OAC. Of the untreated patients, 19% had no indication or had declined or had experienced adverse effects other than bleeding on warfarin treatment. The most common reason to withhold OAC was presence of risk factors for bleeding, found in 38% of all untreated patients. Furthermore, a documented reason could be identified to withhold OAC in 75%. Conclusions. Among patients with AF without OAC treatment a reason could be identified to withhold OAC in 75%. The underuse of OAC is estimated to be 25%.

The role of contraindications in prescribing anticoagulants to patients with atrial fibrillation: a cross-sectional analysis of primary care data in the UK

“…Contraindications have often been cited as a reason for not prescribing anticoagulants. 17,[19][20][21] However, this analysis suggests that contraindications do not stop clinicians from prescribing; this agrees with findings from studies in the US and Europe. [22][23][24] It is unclear why many patients with AF without contraindications are not prescribed anticoagulants, while patients with contraindications are.…”

Incidence, type of atrial fibrillation and risk factors for stroke: a population-based cohort study

“…Patients with a diagnosis of AF or an electrocardiogram (ECG) showing AF before January 1, 2011 (n = 2,274) were included in a previous study and were excluded from this one. 13 We also identified 64 additional patients with a diagnosis of AF before January 1, 2011, who were not included in the previous study. These additional 64 patients were excluded from the present study population; they had received their first diagnosis of AF outside the study region before January 1, 2011, mainly at the nearby University Hospital.…”

Thromboprophylaxis in Patients with Atrial Fibrillation: A Real Practice Analysis

“…Le potenziali barriere alla prescrizione di un adeguato trattamento AVK includono: un'inadeguata stratificazione del rischio, l'età avanzata dei pazienti, il rischio percepito di sanguinamenti e di cadute, la difficoltà di gestire un trattamento con warfarin. In particolare, quest'ultima evenienza comporta la necessità di un monitoraggio costante dell'INR, di frequenti aggiustamenti del dosaggio, di restrizioni dietetiche e di valutare e monitorare le interazioni farmacologiche (15,17,22,23). A questo si deve altresì aggiungere la disaffezione del paziente verso la terapia, con conseguente abbandono della stessa (tra il 20 e il 50% dei casi) (17,(24)(25)(26)(27).…”