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(Stroke. 2008;39:7.)
© 2008 American Heart Association, Inc.

Editorials

Barriers to Anticoagulation in Patients With Atrial Fibrillation

Changing Physician-Related Factors

Deirdre A. Lane, PhD Gregory Y.H. Lip, MD, FRCPE

From the Haemostasis, Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, England.

Correspondence to Prof Gregory Y.H. Lip, Haemostasis, Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham B18 7QH, England. E-mail g.y.h.lip@bham.ac.uk

Key Words: anticoagulation • antithrombotics • atrial fibrillation

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 227–230.

Atrial fibrillation (AF) is not a benign cardiac arrhythmia but instead confers a 5-fold increased risk of stroke compared with age-matched people in sinus rhythm.¹ AF patients also have a worse outcome after stroke, with elevated mortality and stroke recurrence rates,² longer hospital stays,³ and lower discharge rates to their own homes.³ Current estimates suggest that AF afflicts 2.2 million Americans,⁴ whereas in the United Kingdom 740 000 individuals are thought to have AF,⁵ with >46 000 new cases being diagnosed each year.⁶ Given the increasing prevalence of AF and the associated thromboembolic complications, there are significant numbers of patients who require chronic oral anticoagulation (OAC).

Current guidelines^7,8 recommend that AF patients at moderate to high risk of stroke should be commenced on chronic anticoagulation with a vitamin K antagonist (VKA). These recommendations are based on data from meta-analyses of 13 randomized controlled trials which have demonstrated significant reductions in stroke^9,10 and mortality¹⁰ with the use of warfarin. Despite the overwhelming evidence of the benefit of warfarin thromboprophylaxis in patients with AF, such therapy remains significantly underused. OAC care varies considerably from country to country and physicians tend to undertreat more than overtreat.^11,12 Physicians’ dilemma of whether to prescribe warfarin is reflected in the recent Euro Heart Survey of AF patients, which revealed that only 67% of patients eligible for VKAs were actually prescribed it,¹³ although actual ‘real-life’ prescription of OAC may be significantly lower than this.

So, why are eligible patients with AF . . . [Full Text of this Article]

Related Article:

Barriers to the Use of Anticoagulation for Nonvalvular Atrial Fibrillation: A Representative Survey of Australian Family Physicians

Melina Gattellari, John Worthington, Nicholas Zwar, and Sandy Middleton
Stroke 2008 39: 227-230. [Abstract] [Full Text] [PDF]

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