Results of Expert MeetingsAddressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: Proceedings, Washington, DC, December 3-4, 2012
Section snippets
Lack of awareness of stroke risk and the risks and benefits of oral anticoagulation
At least one-third of patients diagnosed with AF are unaware of the associated stroke risk.14, 15 Although awareness of stroke risk is increasing among physicians, 16 OAC use varies considerably according to specialty, with primary care physicians prescribing OAC less commonly than cardiologists.17 Unfortunately, time during outpatient clinical encounters is often limited; and AF may be only one of several comorbidities to be addressed in any given office visit, particularly by general
Conclusions
It is estimated that 50,000 preventable strokes occur annually in the United States alone related to suboptimal anticoagulation care for AF. In view of the opportunity to improve care and public health, interventions to improve OAC use are needed at the levels of patients, providers, and health care systems. Patients and providers would benefit from increased awareness of stroke risk and the effects of treatment, which may be achieved with the implementation of educational initiatives and
Acknowledgements
We give special recognition to Robert Temple, MD, for his important contributions to this manuscript.
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Anticoagulation under-utilization in atrial fibrillation patients is responsible for a large proportion of strokes requiring endovascular therapy
2023, Journal of Stroke and Cerebrovascular DiseasesEfficacy of a centralized, blended electronic, and human intervention to improve direct oral anticoagulant adherence: Smartphones to improve rivaroxaban ADHEREnce in atrial fibrillation (SmartADHERE) a randomized clinical trial
2021, American Heart JournalCitation Excerpt :Among those that do, adherence may not be routinely or formally assessed. Stakeholders have advocated for physician assessment of DOAC adherence and structural incentives to improve it,23,24 but professional society guidelines have not provided clarity on how DOACs should be monitored, by whom, or what interventions should be applied.2,3,25 The present study demonstrates that developing a scalable, blended intervention is feasible.
Acceptance of a potential major bleeding among patients with venous thromboembolism on long-term oral anticoagulation: the knowledge of the disease and therapy matters
2020, Thrombosis ResearchCitation Excerpt :The bleeding risk and the VTE recurrence risk should be assessed regularly [16]. Some patients underuse or discontinue oral anticoagulant (OAC) therapy at least in part because of its most feared hemorrhagic side effects and the lack of disease understanding [17]. Little is known about the bleeding acceptance among VTE patients already treated with VKA or NOAC.
Practical use of Direct Oral Anti Coagulants (DOACs) in the older persons with atrial fibrillation.
2020, European Journal of Internal MedicineCitation Excerpt :The benefit of NOACs over VKA has best been demonstrated for edoxaban and apixaban in this patient population [2]. Predisposition to falls is common in frail patients, and is often perceived as an important issue in starting DOACs [41, 42]. Patients on OAT at high risk of falls did not consistently have a significantly increased risk of major bleedings [43–45].
How I manage anticoagulant therapy in older individuals with atrial fibrillation or venous thromboembolism
2019, BloodCitation Excerpt :Furthermore, compared with white patients, African Americans are less likely to be treated with an anticoagulant (odds ratio, 0.28; 95% confidence interval [CI], 0.13-0.60), have poorer INR control when taking a VKA, and are at higher stroke risk.37-39 Although the introduction of NOACs has led to an increased uptake of oral anticoagulants, underuse remains a major concern, especially in the older population, and cost remains a barrier.10,40 Comorbidities (eg, CKD and cognitive impairment), frailty, polypharmacy, and a history of falls further contribute to the underuse of anticoagulants in older patients.