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Patterns and adherence to guidelines of antithrombotic therapy in Thai patients with nonvalvular atrial fibrillation
1Center of Pharmaceutical Outcomes Research, Department ofPharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand. aromj@nu.ac.th
Insights
Antithrombotic therapy adherence in Thai atrial fibrillation (AF) patients varied, with high-risk individuals undertreated and low-risk patients overtreated. This highlights a need for improved quality of care in antithrombotic management.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Antithrombotic therapy is crucial for preventing thromboembolism in atrial fibrillation (AF) patients.
- Studies show inadequate antithrombotic use in high-risk AF patients in Western countries.
- Limited data exists on antithrombotic therapy patterns in Asian populations.
Purpose of the Study:
- To evaluate antithrombotic therapy patterns and guideline adherence in Thai ambulatory patients with nonvalvular AF.
- To assess the relationship between CHADS2 score and prescribed antithrombotic treatments.
Main Methods:
- Retrieved data from an electronic medical database for ambulatory AF patients between June and September 2008.
- Analyzed prescribed antithrombotics and thromboembolism risk factors using the CHADS2 score.
- Focused on 369 non-valvular AF patients for pattern and adherence analysis.
Main Results:
- Among 369 non-valvular AF patients, 37.4% were high-risk, 34.4% intermediate-risk, and 28.2% low-risk for stroke.
- Warfarin was prescribed to 70.3% of high-risk patients, while 19.6% received antiplatelets and 10.1% received no therapy.
- Low- and intermediate-risk patients showed 51.0% and 52.8% warfarin use, respectively, indicating potential overtreatment.
Conclusions:
- A significant proportion of high-risk non-valvular AF patients in Thailand do not receive recommended anticoagulation.
- Low-risk patients appear to be overtreated with anticoagulants.
- Findings necessitate policy interventions to enhance the quality of antithrombotic care for AF patients.
Background:
Antithrombotic therapy is essential in patients with atrial fibrillation (AF) to prevent systemic thromboembolism, particularly ischemic stroke. Several studies conducted in North America and European countries revealed that AF patients at high risk for thromboembolism did not adequately receive antithrombotic therapy as recommended by relevant guidelines. However such a few studies were reported from Asian countries.
Objective:
To describe patterns and adherence to the guideline of antithrombotic therapy in ambulatory patients with nonvalvular AF in Thailand.
Material And Method:
From an electronic medical database, data of all patients that were diagnosed with AF and presented to the ambulatory care clinic between June 1 and September 30, 2008 were retrieved for analysis. The most recently prescribed antithrombotics and associated risk factors for thromboembolism were reviewed for patterns and adherence to guidelines of antithrombotic therapy according to the CHADS2 (congestive heart failure, hypertension, age >75, diabetes and stroke/transient ischemic attack) score.
Results:
Five hundred thirteen AFpatients were identified, ofthese, 369 patients had no valvular heart diseases or replacement and were recruited into data analysis. Among non-valvularAF patients, 138 (37.4%), 127 (34.4%), and 1l04 (28.2%) patients were classified as high (CHADS2 score > or =2), intermediate (CHAD S2 = I), and low (CHADS2 = 0) risk for ischemic stroke, respectively. Patients who were classified as low and intermediate risk were prescribed warfarin as antithrombotic therapy in 51.0% and 52.8%, respectively. Among high-risk patients, 70.3% were prescribed warfarin while 19.6% received only antiplatelets and 10.1% received no antithrombotic therapy.
Conclusion:
The present study has demonstrated that a proportion of non-valvular AF patients at high-risk for ischemic stroke had not received anticoagulation therapy as recommended by relevant guidelines. Further low-risk patients were over-treated with anticoagulants. The finding should prompt health care policy makers to take action to improve quality of care for these patients.
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