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Decision making for oral anticoagulants in atrial fibrillation: the ATA-AF study

Gualberto Gussoni1, Giuseppe Di Pasquale, Giorgio Vescovo

  • 1FADOI Foundation Research Department, Milano, Italy. gualberto.gussoni@gmail.com

European Journal of Internal Medicine
|May 21, 2013
PubMed

Insights

Vitamin K antagonists (VKA) are effective for preventing stroke in atrial fibrillation (AF) but are underprescribed. Prescription patterns vary by specialty and patient risk factors, indicating a need for improved guideline adherence.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Pharmacology

Background:

  • Oral anticoagulants are the preferred stroke prevention in atrial fibrillation (AF).
  • Vitamin K antagonists (VKA) are underutilized despite guidelines.
  • This study surveyed VKA prescription practices in AF patients.

Purpose of the Study:

  • To assess the current prescription patterns of VKA in patients with AF.
  • To identify factors influencing VKA prescribing decisions.
  • To evaluate the alignment of VKA use with stroke and bleeding risk stratification.

Main Methods:

  • A large survey of 7148 patients across 196 Internal Medicine and 164 Cardiology centers.
  • Evaluation of thrombotic risk using CHADS2 and CHA2DS2VASc scores.
  • Assessment of bleeding risk using a modified HAS-BLED score.

Main Results:

  • VKA were prescribed in 55.5% of non-valvular AF patients, with higher rates in Cardiology (64.2%) vs. Internal Medicine (46.3%).
  • High-risk patients (CHADS2≥2) received VKA less frequently than recommended (55.5% overall).
  • Independent predictors of VKA non-use included advanced age, cognitive impairment, and high bleeding risk.

Conclusions:

  • VKA use in AF patients is influenced by specialty and individual patient characteristics beyond risk scores.
  • Cardiology departments demonstrate higher VKA prescription rates compared to Internal Medicine.
  • Further efforts are needed to improve guideline adherence for VKA prescription in AF.
Abstract

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