FROM CLINICAL-TRIALS TO CLINICAL-PRACTICE - ORAL ANTICOAGULATION AMONG PATIENTS WITH NONRHEUMATIC, ATRIAL-FIBRILLATION

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.