R. Llop et al., FROM CLINICAL-TRIALS TO CLINICAL-PRACTICE - ORAL ANTICOAGULATION AMONG PATIENTS WITH NONRHEUMATIC, ATRIAL-FIBRILLATION, European Journal of Clinical Pharmacology, 53(1), 1997, pp. 1-5
Objectives: The aim of the present study was to evaluate the impact of
the results of clinical trials on the prophylactic treatment of non-r
heumatic atrial fibrillation with oral anticoagulants. Methods: Retros
pectively, we studied a random sample of 375 patients discharged from
our hospital with a diagnosis of non-rheumatic atrial fibrillation bet
ween 1991 and 1993. Information about diagnoses, other clinical variab
les and treatments prescribed at discharge was obtained from the hospi
tal medical records. Results: During the whole study period, 14% of pa
tients were prescribed an oral anticoagulant agent and 17% were prescr
ibed acetylsalicylic acid. A non-significant increase in the proportio
n of patients prescribed oral anticoagulant drugs, from 9% to 17%, was
observed. Multivariate analysis showed that a history of stroke (OR =
5.96) and younger age were significantly associated with the prescrip
tion of oral anticoagulants. ASA prescription was strongly associated
with a history of concomitant vascular disease (OR = 5.8), but not wit
h other risk factors for stroke. Sixty-five percent of patients had on
e or more risk factors for stroke, did not present any contraindicatio
ns to anticoagulant agents, but nevertheless were not prescribed one o
f these drugs. Conclusions: Anticoagulant agents and acetylsalicylic a
cid were largely underprescribed to patients with nonrheumatic atrial
fibrillation, and oral anticoagulants were not prescribed according to
the individual patients' risk of stroke.