Hospitalized Patients With Atrial Fibrillation and a High Risk of Stroke Are Not Being Provided With Adequate Anticoagulation

Abstract

This study confirms the under-use of warfarin, but also adds to published reports in several regards. It showed that risk stratification, the guidepost for treatment in international guidelines, had little effect on warfarin use, and that age >80 years and AF classification (permanent/persistent) are factors that influence warfarin use.

Vitamin K supplementation can improve stability of anticoagulation for patients with unexplained variability in response to warfarin

“…Reducing the within-patient variability in anticoagulation response to warfarin has the potential to improve the clinical effectiveness of this valuable but problematic therapy. Reducing the risk of bleeding or thromboembolic complications associated with over-and under-anticoagulation, respectively, would reduce the concern of clinicians about warfarin therapy for older patients with atrial fibrillation, 30,31 thus widening use of the drug in these patients. Improving anticoagulation control would also allow reduction in frequency of monitoring of patients with unstable control, with reductions in the associated costs of anticoagulation therapy and improved patient quality of life.…”

Approach to and management of the acute stroke patient with atrial fibrillation: A literature review

“…4,8,32 The National Anticoagulation Benchmark Outcomes Report has shown that in the highest risk atrial fibrillation patients, only 55% receive warfarin and 21% do not receive aspirin or warfarin. 33 This discrepancy results from the fact that warfarin is the second most common drug, after insulin, responsible for adverse drug events in emergency room visits. In atrial fibrillation patients on warfarin who present to the emergency with an acute stroke, there are no clear guidelines regarding the continued use of warfarin at therapeutic doses (target INR 5 2.0-3.0).…”

“…32 It has been suggested that macroalbuminuria is an independent predictor of hemor-rhagic transformation and particularly of severe hemorrhage in patients with acute ischemic stroke, but specific guidelines for screening or special management of those patients do not currently exist. 33 ICH is a medical emergency with high mortality and should be recognized and treated promptly. Recently, the AHA and ASA have published updated guidelines for the management of spontaneous ICH in adults.…”

Untreated atrial fibrillation in the United Kingdom: Understanding the barriers and treatment options

“…Despite the fact that oral anticoagulation is effective in preventing strokes due to AF, there is extensive evidence suggesting that this therapy remains underused [7,[11][12][13][14]. In fact, although current guidelines clearly define indications for anticoagulation treatment and its vast impact in the prevention of stroke, barriers to the implementation of oral anticoagulation continue to exist among physicians and patients.…”