American Journal of Cardiovascular Drugs

, Volume 16, Issue 3, pp 183–200 | Cite as

Suboptimal Use of Oral Anticoagulants in Atrial Fibrillation: Has the Introduction of Direct Oral Anticoagulants Improved Prescribing Practices?

  • Endalkachew A. AlamnehEmail author
  • Leanne Chalmers
  • Luke R. Bereznicki
Systematic Review


Background and Objectives

Atrial fibrillation (AF) and the associated risk of stroke are emerging epidemics throughout the world. Suboptimal use of oral anticoagulants for stroke prevention has been widely reported from observational studies. In recent years, direct oral anticoagulants (DOACs) have been introduced for thromboprophylaxis. We conducted a systematic literature review to evaluate current practices of anticoagulation in AF, pharmacologic features and adoption patterns of DOACs, their impacts on proportion of eligible patients with AF who receive oral anticoagulants, persisting challenges and future prospects for optimal anticoagulation.

Literature Source and Selection Criteria

In conducting this review, we considered the results of relevant prospective and retrospective observational studies from real-world practice settings. PubMed (MEDLINE), Scopus (RIS), Google Scholar, EMBASE and Web of Science were used to source relevant literature. There were no date limitations, while language was limited to English. Selection was limited to articles from peer reviewed journals and related to our topic.


Most studies identified in this review indicated suboptimal use of anticoagulants is a persisting challenge despite the availability of DOACs. Underuse of oral anticoagulants is apparent particularly in patients with a high risk of stroke. DOAC adoption trends are quite variable, with slow integration into clinical practice reported in most countries; there has been limited impact to date on prescribing practice.


Available data from clinical practice suggest that suboptimal oral anticoagulant use in patients with AF and poor compliance with guidelines still remain commonplace despite transition to a new era of anticoagulation featuring DOACs.


Atrial Fibrillation Warfarin International Normalize Ratio Dabigatran Rivaroxaban 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with Ethics Guidelines


No external funding was used in the preparation of this manuscript.

Disclosure/conflict of interest

Endalkachew Admassie Alamneh has no conflicts of interest that might be relevant to the contents of this manuscript. Leanne Chalmers has received consultancy funding from Aspen Pharmacare Australia. Luke Bereznicki has received consultancy funding to research activities regarding anticoagulant medications from Roche Diagnostics, Boehringer Ingelheim and Aspen Pharmacare Australia. In 2015, he was a member of the Pradaxa Advisory Board in Australia.


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Endalkachew A. Alamneh
    • 1
    Email author
  • Leanne Chalmers
    • 1
  • Luke R. Bereznicki
    • 1
  1. 1.Division of PharmacySchool of Medicine, University of TasmaniaTasmaniaAustralia

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