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Updated: Aug 15, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Antithrombotic therapy prescribed for patients with non-rheumatic atrial fibrillation
A Hendry1, A M Campbell, G Campbell
1Department of Geriatric Medicine, Gartnavel General Hospital, Glasgow.
Insights
Patients with atrial fibrillation (AF) face a high stroke risk. Despite evidence, anticoagulation therapy for non-rheumatic AF is underutilized in clinical practice.
Area of Science:
- Cardiology
- Geriatrics
- Clinical Practice Research
Background:
- Non-rheumatic atrial fibrillation (AF) significantly increases stroke risk (fivefold).
- Warfarin therapy can reduce this risk by approximately two-thirds.
- Evidence supporting aspirin's benefit in AF stroke prevention is less conclusive.
Purpose of the Study:
- To evaluate current clinical practice regarding antithrombotic therapy for patients with non-rheumatic AF.
- To determine if trial evidence for stroke prevention in AF is reflected in patient management.
Main Methods:
- Retrospective case record study of 131 patients admitted to medical or geriatric units.
- Analysis of patient demographics, AF type, contraindications to anticoagulation, and prescribed antithrombotic treatments (warfarin, aspirin).
Main Results:
- Of 115 patients with non-rheumatic AF, 36% had contraindications to anticoagulation.
- Despite 69% having no contraindications, only 2 were on warfarin and 15 on aspirin pre-admission.
- A significant proportion (53%) of eligible patients were discharged without antithrombotic therapy.
Conclusions:
- Anticoagulation for non-rheumatic AF is significantly underprescribed.
- Current clinical practice does not adequately reflect evidence supporting stroke prevention in AF patients.
- There is a critical need to improve the implementation of antithrombotic guidelines for AF.
Abstract:
Patients with non-rheumatic atrial fibrillation have a fivefold increased risk of stroke. Warfarin reduces this risk by approximately two thirds, but evidence for benefit from aspirin is less compelling. We assessed whether our current practice reflects the message of the trials. In a retrospective case record study we reviewed notes of 131 patients with atrial fibrillation (AF), mean age 79 (range 53-95) years, admitted to a medical unit (72) or geriatric assessment unit (59). Thirty-two patients had paroxysmal AF. Of 115 patients with nonrheumatic AF, 36 (31%) had one or more recorded contraindication to anti-coagulation. Although 79 patients (69%) had no recorded contraindication to warfarin, only 2 took warfarin and 15 aspirin prior to admission. Ten patients commenced warfarin and 8 aspirin before discharge. Thirty-nine patients (53%) without contraindication, were discharged without antithrombotic therapy. Despite evidence to support anticoagulating patients with non-rheumatic AF, this rarely occurs.
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