Reducing Stroke Risk in Atrial Fibrillation: Adherence to Guidelines Has Improved, but Patient Persistence with Anticoagulant Therapy Remains Suboptimal

Abstract

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Oral Anticoagulants Preference in Hospitalized Patients with Acute Deep Vein Thrombosis or Non-Valvular Atrial Fibrillation

“…A gradual increase in the proportion of DOAC usage in AF treatment was recently documented all over the world [ 11 , 12 , 13 ]. DOACs are initiated more frequently than VKA in numerous countries [ 11 , 13 , 14 ], contributing to an increase in appropriate prescribing of anticoagulants in AF.…”

“…A gradual increase in the proportion of DOAC usage in AF treatment was recently documented all over the world [ 11 , 12 , 13 ]. DOACs are initiated more frequently than VKA in numerous countries [ 11 , 13 , 14 ], contributing to an increase in appropriate prescribing of anticoagulants in AF. Despite DOACs’ current large availability and the increasing adherence to anticoagulation guidelines, sub-optimal anticoagulation in AF [ 13 , 15 ] and inappropriate use at DOAC initiation still represent pertinent issues [ 16 ].…”

“…In other similar studies on hospitalized patients with AF, the proportion of DOAC use was higher, from 35% in another hospital in Romania [ 18 ] to more than 50% in Greece [ 19 ]. Compelling data prove that DOACs are now the preferred therapy for initiation of OA in patients with AF, including in patients at higher risk of stroke or bleeding [ 11 , 13 ]. VKA were more likely to be administered in patients with AF, as they had indication for indefinite anticoagulation.…”

Use of Non-vitamin K Antagonist Oral Anticoagulants for Stroke Prevention across the Stroke Spectrum: Progress and Prospects

“…38,112,113 Patient-level factors also contribute to poor adherence and persistence to treatment, such as financial barriers or treatment burden. 115 Failure to reduce the dose of NOACs in patients with renal disease, in whom it is indicated, may result in an increase in the risk of bleeding; in contrast, inappropriate dose reduction, that is, inconsistent with the label, may decrease the effectiveness of stroke prevention. 38 Results from a large real-world cohort study demonstrated that lower doses of apixaban in patients with normal or mildly reduced renal function were found to increase the risk of stroke by approximately five times compared with the standard dose.…”

Results of decision support system implementation for prescribing anticoagulants to patients with atrial fibrillation in hospital

“…Оральные антикоагулянты (АК) эффективно снижают риск ишемического инсульта у пациентов с ФП [4], однако недостаточный охват антикоагулянтной терапией (АКТ) [1], назначение субтерапевтических доз АК [2,3] и неудовлетворительная приверженность АКТ [4] могут ослабить профилактический эффект. По разным данным, 25-50% пациентов с ФП, нуждающихся в АК, не получают терапию [5,6]. Чаще всего это связано с пожилым возрастом пациента, высоким риском кровотечения (из-за онкологических заболеваний, высокого риска падений и т.д.…”