| XML | Respond to this article | Alert & updates | Request permissions | Email to a friend |
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 AF patients were identified, of these, 369 patients had no valvular heart diseases or replacement and were recruited into data analysis. Among non-valvular AF patients, 138 (37.4%), 127 (34.4%), and 104 (28.2%) patients were classified as high (CHADS2 score ≥2), intermediate (CHADS2 = 1), 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.
Keywords: Atrial fibrillation, Anticoagulation, Antithrombotics, Thromboembolism, Warfarin