LINKING THEORY TO PRACTICE: UNDERUSE OF CHRONIC ORAL ANTICOAGULATION IN ATRIAL FIBRILLATION
The effectiveness of chronic oral anticoagulation in preventing thromboembolic events related to atrial fibrillation has already been proven. Nevertheless, a suboptimal use of oral anticoagulants is documented in real-world practice. Aim: To characterize individuals diagnosed with atrial fibrillation in need of chronic oral anticoagulation for thromboembolic prophylactic purposes, focusing on primary reasons of inadequate anticoagulation (lack of recommendation from the attending physician, inappropriate dosing and/or presence of contraindications). Material and methods: Patients presenting atrial fibrillation on admission or having been previously diagnosed with at least one episode of atrial fibrillation were included. Parameters like the type of atrial fibrillation (newly diagnosed, paroxysmal, persistent, permanent), associated thromboembolic and bleeding risk factors, as well as the long-term use of oral anticoagulants were assessed. Results: The study group comprised 90 subjects (mean age 75.83 ± 8.75 years, 40% men). All patients associated high thromboembolic risk according to CHA2DS2-VASC score. In one third of the patients no objective reason justifying the lack of anticoagulation was found. A reduced glomerular filtration rate (<60 mL/min/1.73 m2) was noted in 34.4% of the study group. Conclusions: Our study confirmed the underuse of oral anticoagulants in patients with atrial fibrillation. If pathological conditions predisposing to high bleeding risk were excluded, the socioeconomic status represented the main argument when establishing the need for oral anticoagulation. Additional strategies to promote public awareness are needed in patients with atrial fibrillation requiring antithrombotic treatment.
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