Clinical research studyUnderuse of Oral Anticoagulants in Atrial Fibrillation: A Systematic Review
Section snippets
Literature Search
An extensive search of recent biomedical literature was performed using PubMed for studies pertaining to current treatment practices for stroke prevention for atrial fibrillation patients; the search was limited to studies on humans, published after May 1997. Combinations of the following search terms were used: practices, treatment, atrial fibrillation, stroke, antithrombotics, antiplatelets, oral anticoagulants, warfarin, and vitamin K antagonist. Studies were excluded if no stroke risk
Current Treatment Practices
In all, 54 studies were selected from a possible 98 that pertained to treatment of atrial fibrillation patients with oral anticoagulation therapy (Figure 1). The study populations were mostly elderly (over 65 years old). Of the 54 selected studies, 29 contained treatment data for atrial fibrillation patients with prior stroke or transient ischemic attack; these were used for the primary analysis. Additionally, 9 of the 54 studies presented treatment data for atrial fibrillation patients based
Discussion
This systematic review and analysis of available evidence has highlighted suboptimal treatment of high-risk atrial fibrillation patients. Patients with atrial fibrillation and prior stroke or transient ischemic attack were found to be under-treated with oral anticoagulation therapy in the majority of studies. Over two thirds of studies analyzed reported treatment levels of high-risk patients under 60%. Similarly, high-risk subjects based on CHADS2 stroke risk score also were suboptimally
Conclusion
This systematic review demonstrates that a large proportion of patients with atrial fibrillation who are at high risk of stroke are under-treated with oral anticoagulation, highlighting the need for improvements in thromboprophylaxis for atrial fibrillation.
Acknowledgment
The authors wish to thank Annabelle Shakespeare at Bayer Healthcare, UK, for her help with study design, literature search and data review.
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Funding: This study was funded by Bayer Healthcare, UK.
Conflict of Interest: Dr. Gregory Y.H. Lip has acted as a consultant for Bayer Healthcare, AstraZeneca, Astellas, and Boehringer; and Warren Cowell is employed by Bayer Healthcare, UK. The other authors have no conflict of interest.
Authorship: All authors had full access to data for this study and participated in writing and review of the manuscript.