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Adherence to clinical guidance in the prescribing of oral antithrombotic medication in patients with atrial fibrillation

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Abstract

Background

Atrial fibrillation is the commonest cardiac rhythm disturbance and is an independent risk factor for stroke; however, use of oral antithrombotic therapy is reported to be suboptimal in clinical practice.

Aim

The aim of the study was to evaluate the prescribing rates of oral antithrombotic therapy in patients with atrial fibrillation to determine if prescribing patterns reflected published clinical guidance.

Method

Patients with atrial fibrillation, admitted to hospital over a 12-week period were identified and their antithrombotic therapy regimen was analysed using statistical methods.

Results

Although 87/100 patients identified were prescribed OAT, the regimen was sub-optimal in 35 patients. Patients aged 75 years and older were more likely to be receiving suboptimal oral antithrombotic treatment compared with younger patients

Conclusions

The benefits and suitability of oral antithrombotic therapy for patients of all ages need to be more comprehensively communicated to prescribers.

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References

  1. Lip GYH, Hart RG, Conway DSG.ABC of antithrombotic therapy: Antithrombotic therapy for atrial fibrillation.BMJ 2002; 325: 1022–5.

    Article  PubMed  Google Scholar 

  2. Albers GW, Dalen JE, Laupacis A, Manning WJ, Peterson P, Singer DE. Antithrombotic therapy in atrial fibrillation.Chest 2001; 119: S194-S206.

    Article  Google Scholar 

  3. Rockson SG, Albers GW. Comparing the guidelines: Anticoagulation therapy to optimise stroke prevention in patients with atrial fibrillation.J Am Coll Cardiol 2004; 43(6): 929–935

    Article  PubMed  Google Scholar 

  4. Deplanque D, Leys D, Parnetti L et al. Stroke prevention and atrial fibrillation: reasons leading to an inappropriate management. Main results of the SAFE II study.Br J Clin Pharmacol 2004; 57(6): 798–806

    Article  PubMed  Google Scholar 

  5. McCormick D, Gurwitz JH, Goldberg RJ et al. Prevalence and quality of warfarin use for patients with atrial fibrillation in the long-term care setting.Arch Intern Med 2001; 161(20): 2458–2463

    Article  CAS  PubMed  Google Scholar 

  6. Fang MC, Stafford RS, Ruskin JN, Singer DE. National trends in antiarrhythmic and antithrombotic medication use in atrial fibrillation.Arch Intern Med 2004; 164 (1): 55–60.

    Article  PubMed  Google Scholar 

  7. Oral anticoagulants. In:British National Formulary [50th Edition]. British Medical Association and Royal Pharmaceutical Society of Great Britain, London 2005: 123–4

  8. Gage BF, Boechler M, Doggette AL et al. Adverse Outcomes and Predictors of Underuse of Antithrombotic Therapy in Medicare Beneficiaries with Chronic Atrial Fibrillation.Stroke 2000; 31: 822–7

    CAS  PubMed  Google Scholar 

  9. Fuller R, Dudley N, Blacktop J. Avoidance hierarchies and preferences for anticoagulation — semi-qualitative analysis of older patients’ views about stroke prevention and the use of warfarin.Age Ageing 2004; 33 (6): 608–11

    Article  PubMed  Google Scholar 

  10. Howitt A, Armstrong D. Implementing evidence based medicine in general practice: Audit and qualitative study of antithrombotic treatment for atrial fibrillation.BMJ 1999; 318: 1324–1327.

    CAS  PubMed  Google Scholar 

  11. Protheroe J, Fahey T, Montgomery AA, Peters TJ. The impact of patients’ preferences on the treatment of atrial fibrillation: observational study of patient based decision analysis.BMJ 2000; 320: 1380–1384.

    Article  CAS  PubMed  Google Scholar 

  12. Heneghan C, Alonso-Coello P, Garcia-Alamino JM, Perera R, Meats E, Glasziou P. Self-monitoring of oral anticoagulation: a systematic review and meta-analysis.Lancet 2006; 367: 404–11.

    Article  CAS  PubMed  Google Scholar 

  13. White S, Feely J, O’Neill D. Community-based Study of Atrial Fibrillation and Stroke Prevention.Ir Med J 2004; 97(1): 10–12.

    CAS  PubMed  Google Scholar 

  14. Devereaux PJ, Anderson DR, Gardner MJ et al. Differences between perspectives of physicians and patients on anticoagulation in patients with atrial fibrillation: observational study.BMJ 2001; 323: 1–7

    Article  Google Scholar 

  15. Choudhry N, Anderson G, Laupacis A, Ross-Degnan D, Normand S, Soumerai S. Impact of adverse events on prescribing of warfarin in patients with atrial fibrillation: matched pair analysis.BMJ 2006; 332: 141–3

    Article  PubMed  Google Scholar 

  16. Brophy MT, Snyder KE, Gaehde S, Ives C, Gagnon D, Fiore LD. Anticoagulant use for Atrial Fibrillation in the Elderly.J Am Geriatr Soc 2004; 52: 1151–1156.

    Article  PubMed  Google Scholar 

  17. McCormick D, Gurwitz JH, Goldberg RJ, Ansell J. Long-Term Anticoagulation Therapy for Atrial Fibrillation in Elderly Patients: Efficacy, Risk, and Current Patterns ofUse.J Thromb Thrombolysis 1999; 7: 157–163.

    Article  CAS  PubMed  Google Scholar 

  18. Fihn SD, Callahan CM, Martin DC, McDonell MB, Henikoff JG, White RH. The Risk for and Severity of Bleeding Complications in Elderly Patients Treated with Warfarin.Ann Intern Med 1996; 124: 970–979.

    CAS  PubMed  Google Scholar 

  19. Oswald N, Bateman H. Treating individuals according to evidence: why do primary care practitioners do what they do?J Eval Clin Pract 2002; 6(2): 139–148.

    Article  Google Scholar 

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Correspondence to M. Teeling.

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Savage, M., Teeling, M., Bennett, K. et al. Adherence to clinical guidance in the prescribing of oral antithrombotic medication in patients with atrial fibrillation. Ir J Med Sci 175, 46–49 (2006). https://doi.org/10.1007/BF03167949

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  • DOI: https://doi.org/10.1007/BF03167949

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