Flaws in Anticoagulation Strategies in Patients With Atrial Fibrillation at Hospital Discharge

Abstract

Background: Proper anticoagulation is a crucial therapeutic regimen in atrial fibrillation (AF). Objectives: To evaluate the reallife anticoagulation prescriptions of AF patients upon hospital discharge. Methods: We studied 768 patients with comorbid AF who were discharged from the cardiology ward of a tertiary hospital. We assessed the appropriateness of oral anticoagulation (OAC) regimens at discharge based on stroke risk (CHA 2 DS 2-Vasc score), SAMe-TT 2 R 2 (sex, age, medical history, treatment, tobacco, race) score for vitamin K antagonists (VKA), and European labeling for nonvitamin K oral anticoagulant (NOAC) dosing. Logistic regression identified factors associated with suboptimal OAC use. Results: Of 734 patients at significant (moderate or high) stroke risk, 107 (14.6%) were not prescribed OAC, which was administered to 23 (67.6%) of 34 patients at low risk. Nonprescribing of OAC to high-risk patients was associated with paroxysmal AF (adjusted odds ratio [OR]: 2.42, 95% confidence interval [

Non-adherence to Thromboprophylaxis Guidelines in Atrial Fibrillation: A Narrative Review of the Extent of and Factors in Guideline Non-adherence

“…[40] When it comes to overtreatment, between 0.6% and 79.8% of patients at low risk of stroke who did not need any antithrombotic medication received treatment, which would be considered to be overtreatment. [18,22,26,31,33,35,[43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62] Recent studies that investigated trends in guideline adherence have shown substantial improvements in guideline adherence over time. Cowan et al [63] reported an increase in the prescription of OACs (by 30.6%) and a decline in the prescription of antiplatelet agents (by 26.8%) over a 10-year period in AF patients at high risk of stroke.…”

“…In all studies that provided data for high-risk patients, undertreatment was considered when OACs were not prescribed in these patients. [22,33,41,45,46,49,51,53,54,56,63,64,72,73,76] Similarly, prescription of any antithrombotic agent in patients with a low risk of stroke was considered as overtreatment. [22,45,46,51,54,56,76] Hospital-based studies in Turkey [20] and Greece [49] reported that 28.3% and 16.9% of patients with NVAF received guideline non-adherent treatments, respectively.…”

“…[22,33,41,45,46,49,51,53,54,56,63,64,72,73,76] Similarly, prescription of any antithrombotic agent in patients with a low risk of stroke was considered as overtreatment. [22,45,46,51,54,56,76] Hospital-based studies in Turkey [20] and Greece [49] reported that 28.3% and 16.9% of patients with NVAF received guideline non-adherent treatments, respectively. Another hospital-based study from France included only elderly patients aged 75 years or older.…”

“…Most of the remaining hospital-based studies reported guideline non-adherence based on the patients' risk of stroke. Accordingly, undertreatment in patients at high-risk of stroke ranges from 14.6% in Greece [49] to 59.1% in Italy and Spain [74]. Findings from studies incorporating multiple practice sites show similar rates of guideline non-adherence in high-risk patients where 15.7%-25.6% of patients received undertreatment.…”

Gender-Related Differences In Treatment Patterns And Outcomes of Patients With Atrial Fibrillation: Insights From The MISOAC-AF Trial

“…However, Lip et al have suggested that thromboprophylaxis is underused in AF patients of both genders and more so in those with higher CHADS2-VASc scores [16,17]. It has been suggested that acutely hospitalized patients could be at the center of this paradox, as their severe main illness may divert physicians from prescribing OAC treatment [18].…”