Related Experiment Video

Updated: Mar 28, 2026

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

34.3K

Underuse of anticoagulation in patients with atrial fibrillation

Ajay Vallakati1, William R Lewis1

  • 1a Division of Cardiovascular Diseases , Metrohealth Medical Center , Cleveland , OH , USA.

Postgraduate Medicine
|December 16, 2015
PubMed

Insights

Physicians often hesitate to prescribe anticoagulation for atrial fibrillation (AF) due to omission bias, leading to underuse. Strategies to improve guideline adherence and patient compliance are crucial for preventing ischemic strokes.

Area of Science:

  • Cardiology
  • Neurology
  • Health Services Research

Background:

  • Atrial fibrillation (AF) significantly increases ischemic stroke risk.
  • Current guidelines recommend anticoagulation for AF patients with CHA2DS2-VASc score ≥ 2.
  • Anticoagulant underuse in eligible AF patients is a persistent clinical challenge.

Purpose of the Study:

  • To review the reasons for underuse of anticoagulation in atrial fibrillation.
  • To examine the role of omission bias in physician hesitancy towards prescribing anticoagulation.
  • To discuss strategies for improving guideline adherence and patient compliance.

Main Methods:

  • Literature review of studies on anticoagulation underuse in AF.
  • Analysis of psychological factors, including omission bias, influencing treatment decisions.
  • Examination of quality improvement initiatives like the Get With The Guidelines-AFIB (GWTG-AFIB) program.

Main Results:

  • Omission bias contributes to physician reluctance and inaccurate stroke risk assessment.
  • Initiatives like GWTG-AFIB aim to enhance guideline adherence.
  • Nonvitamin K antagonist oral anticoagulants may improve patient adherence.

Conclusions:

  • Addressing omission bias and improving adherence are key to optimizing stroke prevention in AF.
  • Enhanced patient education and established protocols can improve compliance.
  • Optimizing anticoagulation therapy in AF is essential for reducing stroke incidence.

Keywords:
AnticoagulantsAtrial fibrillationNonvitamin K antagonist oral anticoagulantsStrokeUnderuseWarfarin

More Related Videos

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation23:33

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

84.7K
Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock07:39

Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock

Published on: August 16, 2021

4.3K

Related Concept Videos

Anticoagulant Drugs: Low-Molecular-Weight Heparins01:30

Anticoagulant Drugs: Low-Molecular-Weight Heparins

Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
2.3K
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
2.7K
Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
465
Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors01:20

Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors

Antiplatelet drugs emerge as frontline defenders against the insidious threat of thromboembolic diseases, where abnormal clots obstruct vital blood vessels. These drugs stand as bulwarks, inhibiting platelet aggregation and clot formation, thereby mitigating the risk of life-threatening conditions like myocardial infarction, coronary artery disease, and thrombotic strokes.
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
1.5K
Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
549
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
1.4K