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Antithrombotic therapy in patientswith non-valvular atrial fibrillation in Southern Sweden: A population-based cohort study
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2016 (English)In: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 140, 94-99 p.Article in journal (Refereed) PublishedText
Abstract [en]

Introduction: Oral anticoagulants in patients with atrial fibrillation (AF) with moderate-to-high stroke risk are strongly recommended by the current guidelines.

Materials and methods: Population-based register study of all 13,837 patients with incident non-valvular AF diagnosed during 2011-2014 in primary and secondary care (including all in-and outpatient visits) in Skane County, Sweden. The outcome was the prescription of direct-acting oral anticoagulants (DOAC), warfarin or acetylsalicylic acid (ASA).

Results and conclusion: Guideline adherence increased from 47.6% in 2011 to 66.1% in 2014, mostly due to decrease in undertreatment. In patients with CHA(2)DS(2)-VASc score >= 2, ASA uptake decreased from 29.9% to 14.7% and DOAC uptake increased from 2.1% to 25.1%. The use of ASA was more common among elderly and with increasing stroke-and bleeding risk. Overall, 47.4% of patients with CHA(2)DS(2)-VASc score >= 2 did not receive oral anticoagulants. Undertreatment was particularly common in women < 65 years (55.8%) and in patients >84 years (65.3% in women and 62% in men). Overtreatment of patients at low stroke risk was 35.9% in men and 36.4% in women. Provider speciality affected the choice of treatment only to a minor degree. Despite increasing guideline adherence, there is a suboptimal use of antithrombotic therapy in a large proportion of AF patients diagnosed in different clinical settings. Efforts to further improve guideline adherence should particularly be targeted on women < 65 years, elderly > 84 years and patients at low stroke risk.

Place, publisher, year, edition, pages
2016. Vol. 140, 94-99 p.
Keyword [en]
Anticoagulants, Atrial fibrillation, Guideline adherence, Hemorrhage, Stroke
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:umu:diva-120642DOI: 10.1016/j.thromres.2016.02.023ISI: 000373732600015PubMedID: 26938155OAI: oai:DiVA.org:umu-120642DiVA: diva2:953358
Available from: 2016-08-17 Created: 2016-05-18 Last updated: 2016-08-17Bibliographically approved

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Själander, Anders
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Department of Public Health and Clinical Medicine
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