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Published on: February 28, 2012
Utilization of antithrombotic therapy for stroke prevention in atrial fibrillation: a cross-sectional baseline
B Bajorek1, P J Magin2, S Hilmer3
1Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia.
Insights
Antithrombotic therapy for stroke prevention in atrial fibrillation (AF) is now widely used in Australian general practice. Warfarin remains the primary treatment, with novel oral anticoagulants emerging.
Area of Science:
- Cardiology
- General Practice
- Pharmacotherapy
Background:
- Antithrombotic therapy is crucial for stroke prevention in atrial fibrillation (AF).
- Underutilization of these therapies in general practice has been a concern.
- General practice plays a key role in managing AF patients.
Purpose of the Study:
- To assess the current use of antithrombotic therapy for stroke prevention in Australian general practice.
- To identify patterns and trends in antithrombotic prescribing for AF patients.
Main Methods:
- Retrospective data collection from general practice surgeries in New South Wales, Australia.
- Inclusion of patients aged 65 years and older with AF.
- Review of patient medical histories, current medications, and relevant characteristics.
Main Results:
- Nearly all (98.5%) patients received antithrombotic therapy.
- Warfarin, often with an antiplatelet agent, was the most common therapy (81.7%).
- Older patients (≥80 years) were less likely to receive dual or triple therapy.
Conclusions:
- Antithrombotic therapy use for AF stroke prevention in general practice has improved significantly.
- Warfarin is the predominant agent, with novel oral anticoagulants gaining traction.
- Further evaluation of newer agents' impact and appropriate use is warranted.
What Is Known And Objective:
Antithrombotics for stroke prevention in atrial fibrillation (AF) are reportedly underutilised. Since the burden of care lies within general practice, attention must be paid to identifying and addressing practice gaps in this setting. The objective of this study was to determine the contemporary utilisation of antithrombotic therapy for stroke prevention in AF within Australian general practice (GP).
Methods:
Data pertaining to AF patients' (aged ≥65 years) were collected from GP surgeries in New South Wales, Australia, using purpose-designed data collection forms; extracted data comprised patients' medical histories, current pharmacotherapy, and relevant characteristics.
Results And Discussion:
Data pertaining to 393 patients (mean age 78·0 ± 7·0 years) were reviewed. Overall, most (98·5%) patients received antithrombotic therapy. Among the 387 patients using antithrombotics, most (94·1%) received mono-therapy. "Warfarin ± antiplatelet" was most frequently used (81·7%); 77·5% used "warfarin" as a monotherapy, followed by "dabigatran ± clopidogrel" (11·6%), "aspirin" (5·9%) and "clopidogrel" alone (0·8%). High stroke risk and low bleeding risk were associated with increased use of "warfarin ± antiplatelet" therapy. Older patients (≥80 years) were more likely to receive 'nil therapy' (P = 0·04), and less likely to receive dual and triple antithrombotic therapy.
Conclusion:
We found an encouraging improvement compared to previous studies in the utilisation of antithrombotic therapy for stroke prevention in AF within general practice. Warfarin is now utilised as the mainstay therapy, followed by aspirin, although the novel oral anticoagulants are entering the spectrum of therapies used. Consideration needs to be given to the potential impact of the newer agents and their scope of use.
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