ArticleInternal and emergency medicine2007
Underuse of oral anticoagulants in patients with nonvalvular atrial fibrillation in Italy.
Article in Internal and emergency medicine, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 38 citations in OpenAlex.
- New oral anticoagulants for the treatment of acute venous thromboembolism: are they safer than vitamin K antagonists? A meta-analysis of the interventional trials.Internal and emergency medicine · 2015Pooled it
- Can nudge-interventions address health service overuse and underuse? Protocol for a systematic review.BMJ open · 2019Article
- The changing landscape of thromboprophylaxis for atrial fibrillation: insights from the ISPAF-2 survey.Internal and emergency medicine · 2018Article
- Atrial fibrillation in patients with first-ever stroke: Incidence trends and antithrombotic therapy before the event.PloS one · 2018Article
- Article
- Antithrombotic prophylaxis of atrial fibrillation in an Italian real-world setting: a retrospective study.Vascular health and risk management · 2017Observational
- "To treat or not to treat very elderly naïve patients with atrial fibrillation with vitamin K antagonists".Internal and emergency medicine · 2015Article
- Real life anticoagulation treatment of patients with atrial fibrillation in Germany: extent and causes of anticoagulant under-use.Journal of thrombosis and thrombolysis · 2015Observational
- Medication prescription and adherence disparities in non valvular atrial fibrillation patients: an Italian portrait from the ARAPACIS study.Internal and emergency medicine · 2014Article
- Outcome Predictors in First-Ever Ischemic Stroke Patients: A Population-Based Study.International scholarly research notices · 2014Article
- Atrial fibrillation and stroke prevention: is warfarin still an option?--No.Journal of neural transmission (Vienna, Austria : 1996) · 2013Article
- Epidemiology of stroke in northern Italy: the Cerebrovascular Aosta Registry, 2004-2008.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2013Article
- Percutaneous Left Atrial Appendage Exclusion Therapy: Who, Why and How?Journal of atrial fibrillationReview
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionOral anticoagulants (OAs) are significantly more effective than Aspirin in the prevention of cerebrovascular accidents among patients with atrial fibrillation (AF). Several studies, however, showed OAs to be widely underused in these patients.
objectiveTo assess the appropriateness of antithrombotic therapy in an Italian population of AF patients.
methodsTwo hundred and fifty-five consecutive patients affected by nonvalvular AF participated in the study. Data were collected on demographic characteristics, risk factors for stroke, current prophylactic therapy, and perceived or actual risk factors for bleeding. INR levels were measured. Patients were stratified by their risk for stroke (214 at high risk, 21 moderate, 20 low), and their prophylactic therapy was analysed in light of international antithrombotic therapy recommendations. After therapy adjustment, 203 of our patients were followed-up for the occurrence of cerebrovascular events for an average of 27 months.
resultsUpon admission, 35% (n=75) of patients in the high-risk category were either taking no antithrombotic prophylaxis or were being treated with Aspirin. In addition, 38 of 139 patients receiving OAs had an INR<2. Thus, a total of 113 (52.8%) high-risk subjects were not receiving adequate antithrombotic therapy. Of high-risk patients not treated with OAs, 46.7% reported no perceived or actual risk factors for bleeding. The annual incidence of cerebrovascular accidents was 3.8% among 163 high-risk patients assigned to OA treatment, and 4.5% among 39 patients given Aspirin treatment. Relative to expected annual incidence rates, cerebrovascular risk in anticoagulated patients was reduced by about 70%.
conclusionsUnderuse of OAs is still common in Italy, and much of it cannot be explained by the concern for haemorrhage. Support and training in the complex task of anticoagulation management may help to extend this efficacious prophylactic therapy to all patients who may benefit from it.
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