THROMBOEMBOLIC PROPHYLAXIS IN 3575 HOSPITALIZED-PATIENTS WITH ATRIAL-FIBRILLATION

OBJECTIVE: To define contemporary utilization patterns of anticoagulan t and antiplatelet therapy for thromboembolic prophylaxis in atrial fi brillation (AF). DESIGN: Retrospective medical records audit of patien ts admitted in 1993 and 1994. SETTING: Twelve Canadian hospitals. PATI ENTS: Three thousand, three hundred and seventy-five consecutive patie nts with AF; 1570 females and 2005 males. The mean age was 72 years; 1 353 patients were younger than 70 years and 2222 were aged 70 years an d older. MEASUREMENTS AND RESULTS: Overall, 1188 (33%) of the 3575 pat ients received no prophylaxis, 852 (24%) were treated with warfarin al one, 1247 (35%) received acetylsalicylic acid (ASA) alone and 288 (8%) received both drugs. The pattern of medication use did not change app reciably when possible contraindications to warfarin or ASA therapy we re considered. Among the 331 AF patients with valvular heart disease a nd no contraindications to thromboembolic prophylaxis, 65 (20%) receiv ed neither treatment, 181 (55%) received warfarin therapy alone, 46 (1 4%) received ASA alone and 39 (12%) received both. Among the 2199 AF p atients with nonvalvular heart disease and no contraindications, 823 ( 37%) did not receive either therapy, 677 (31%) received ASA alone, 504 (23%) received warfarin alone and 195 (9%) received both. Elderly and female patients were less likely to receive thromboembolic prophylaxi s. CONCLUSIONS: Anticoagulation and antiplatelet prophylaxis in AF app ears to be less than optimal. Although concerns about bleeding may be one reason thromboembolic prophylaxis is so unevenly and incompletely applied, it will be important to determine the reasons for this practi ce and to develop effective strategies in order to enhance the process of care and patient outcomes.