June 26th 2016

Retail clinicians should make sure to check prescribing guidelines when treating patients with atrial fibrillation, especially those who are at high risk for stroke.

Retail clinicians should make sure to check prescribing guidelines when treating patients with atrial fibrillation (AF), especially those who are at high risk for stroke.

Recent study results indicate that aspirin is frequently prescribed for patients with AF, even though anticoagulant therapy is the recommended option for this population.

The study, which was published in theJournal of the American College of Cardiology, analyzed data on 210,380 AF patients who were identified as at-risk for stroke based on the CHADS2 model. Data on a comparable group of 294,642 AF patients who were determined to be at risk for stroke based on the newer CHA2DS2-VASc model were also evaluated.

Only 62% of patients in the CHADS2 group were prescribed anticoagulants, while the remaining 38% received aspirin. In the CHA2DS2-VASc group, 60% of patients were prescribed anticoagulants, while 40% were given aspirin.

Lead study author, Jonathan C. Hsu, MD, suggested that health care providers may be prescribing aspirin instead of anticoagulants because of “the misperception that aspirin exhibits adequate efficacy compared to oral anticoagulants.”

Across both groups, patients who were treated with anticoagulants were generally older and more likely to have a greater body mass index or a history of stroke, blood clot, or congestive heart failure. Meanwhile, those treated with aspirin tended to be younger and more likely to have another medical condition (such as diabetes, hypertension, high cholesterol, coronary artery disease, and peripheral artery disease), a history of heart attack, or prior coronary artery bypass graft surgery.

Notably, women were slightly less likely to be prescribed anticoagulants, even though they face a greater risk for stroke than men. This trend was also observed in aseparate studypublished in theJournal of the American Geriatrics Societythat found women were 1.8 times as likely to be undertreated for AF-related stroke prevention as men.

In an accompanying editorial, Sanjay Deshpande, MD, and L. Samuel Wann, MD, noted that aspirin offers little protection from stroke, and they warned clinicians that the drug may place patients at risk for bleeding.

“It is concerning that the highly motivated, conscientious, and talented cardiologists working in quality-conscious institutions that contribute their data to the National Cardiovascular Data Registry are not prescribing anticoagulation in one-third of their qualifying patients, as defined by our guidelines,” Drs. Deshpande and Wann wrote.

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