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The influence of randomized trials on the use of anticoagulants for atrial fibrillation

G E Mead1, J M Wardlaw, S C Lewis

  • 1Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, UK. GEM@skull.dcn.ed.ac.uk

Age and Ageing
|October 21, 1999
PubMed

Insights

Anticoagulation is underused in atrial fibrillation (AF) patients at high risk of stroke. Despite evidence from randomized trials, clinical practice shows little influence, indicating issues with disseminating trial results.

Area of Science:

  • Neurology
  • Cardiology
  • Clinical Pharmacology

Background:

  • Randomized trials demonstrate anticoagulants and anti-platelet drugs reduce stroke risk in atrial fibrillation (AF).
  • Investigated the use of these drugs in patients with AF prior to a vascular event to assess trial influence on clinical practice.

Purpose of the Study:

  • To assess the influence of randomized trials on the clinical practice of anticoagulant and anti-platelet drug use in patients with atrial fibrillation (AF) before a stroke or transient ischemic attack (TIA).

Main Methods:

  • Prospective identification of inpatients and outpatients with acute stroke, TIA, or retinal artery occlusion from 1990-1997.
  • Recorded AF presence before the event and prior use of anticoagulant/anti-platelet drugs, verified with medical records.

Main Results:

  • 10% of 1934 patients had AF before their ischemic event.
  • Anticoagulant use was significantly higher in AF patients (21%) versus sinus rhythm (2%), OR 14.2.
  • Only 22% of AF patients without contraindications received anticoagulation; no conclusive evidence of trial influence on practice was found.

Conclusions:

  • Anticoagulation is likely underused in atrial fibrillation (AF) patients.
  • Randomized trial results do not appear to have conclusively influenced clinical practice regarding anticoagulation for AF.
  • Dissemination and implementation of trial findings into clinical practice remain significant challenges.
Abstract

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