January 28th, 2014

Problems Persist Despite Gains in Oral Anticoagulant Use

Although significant progress has been made in recent years, a new survey from the European Society of Cardiology finds that there are still too many atrial fibrillation patients who are not taking the best medications to reduce their elevated risk for stroke. Many elderly patients are not receiving oral anticoagulants — either traditional warfarin or one of the newer agents — and overall, too many patients are still taking aspirin, despite the fact that it is not recommended for this group of patients.

In a paper published in the American Journal of Medicine, Gregory YH Lip and colleagues analyzed data from more than 3100 patients surveyed in the Euro Observational Research Programme on Atrial Fibrillation from February 2012 to March 2013. They found that the use of oral anticoagulants has improved over the past decade. A large majority — 72% — received warfarin, while only 8% received one of the newer oral anticoagulants.

“Novel oral anticoagulant uptake is still a bit low, probably because of differences in regulatory approval, costs and access to drugs in different countries,” said Dr. Lip, in an ESC press release. “But the main point is that overall oral anticoagulant uptake as a whole has improved in the last 10 years.”

The authors expressed concern about the persistent high use of aspirin among patients in the survey. “The perception that aspirin is a safe and effective drug for preventing strokes in AF needs to be dispelled,” said Lip. “If anything, you could say that giving aspirin to patients with AF is harmful because it is minimally or not effective at stroke prevention, yet the risk of major bleeding or intracranial haemorrhage is not significantly different to well-managed oral anticoagulation.” Aspirin is commonly prescribed as an antiplatelet agent in patients with coronary artery disease, especially following an acute coronary syndrome. In the survey, AF patients with coronary disease were eight time more likely to be taking aspirin.

A finding of particular concern was the underuse of oral anticoagulants in elderly patients. Said Lip: “Elderly patients are at the highest risk for stroke and yet they are given aspirin which is not recommended and potentially harmful. There is a perception that elderly patients do not do well on anticoagulation.” But, he said, warfarin is actually “far superior” to aspirin in these patients for the prevention of stroke.

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