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December 19, 2013European Journal of General PracticeOpen Access

Use of oral anticoagulants in atrial fibrillation is highly variable and only weakly associated with estimated stroke risk: Cross-sectional population database study

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Key result

OAC prescription reaches ~43% in AF patients and correlates weakly with estimated stroke risk.

  • n=21,564

Why the study?

Current guidelines recommend stroke risk stratification tools to guide oral anticoagulant use in atrial fibrillation, but patterns of use and associated factors remain unclear.

Population

21,564 AF patients without rheumatic heart disease or valve replacement from 315 Scottish General Practices

Comparison

Oral anticoagulant use versus no anticoagulant use by stroke risk category

Design

Cross-sectional multilevel modelling study

Authors

TDTobias DreischulteKBKaren BarnettVMVishnu Madhok

Discussion

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Overview

OAC use in AF remains weakly tied to risk with marked practice variation; leaves open whether risk tools meaningfully improve prescribing or outcomes.

Study Design

Type

Cross-Sectional (n=21,564)

Multicenter

Yes

Structured PICO

P
Population
21,564 patients with atrial fibrillation and without rheumatic heart disease or valve replacement from 315 Scottish General Practices.
E
Exposure
Oral anticoagulants (OAC)
O
Outcome
Patterns of use of antithrombotics by stroke risk and patient/practice characteristics associated with OAC use

Oral anticoagulant prescribing in atrial fibrillation is highly variable across primary care practices and only weakly associated with estimated stroke risk, indicating significant gaps in guideline implementation.

Cite This Study

Dreischulte et al. (2013) conducted a cross-sectional in Atrial fibrillation (n=21,564). Oral anticoagulants was evaluated on Prescription of oral anticoagulants. Among 21,564 patients with atrial fibrillation, 43.3% were prescribed oral anticoagulants, and use was only weakly related to estimated stroke risk.

synapsesocial.com/papers/6aaf7b3fdc4bef2ee7d06e1bhttps://doi.org/10.3109/13814788.2013.852535
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Antithrombotic treatment in real-life atrial fibrillation patients: a report from the Euro Heart Survey on Atrial Fibrillation2006 · 372 citations
  2. 2Antithrombotic treatment and the risk of death and stroke in patients with atrial fibrillation and a CHADS2 score=12010 · 106 citations
  3. 3Attitudes of physicians regarding anticoagulation for atrial fibrillation: a systematic review2011 · 243 citations
  4. 4Bleeding risk assessment and management in atrial fibrillation patients: a position document from the European Heart Rhythm Association, endorsed by the European Society of Cardiology Working Group on Thrombosis2011 · 223 citations
  5. 5Meta-analysis: Antithrombotic Therapy to Prevent Stroke in Patients Who Have Nonvalvular Atrial Fibrillation2007 · 4,828 citations