Characterization of the Proportion of Untreated and Antiplatelet Therapy Treated Patients With Atrial Fibrillation

Study Questions:

How often are patients with atrial fibrillation (AF) inappropriately untreated with an oral anticoagulant (OAC)?


This was a review of 56 published studies that presented data on the percentage of patients with AF treated with an OAC, antiplatelet therapy, or no stroke prevention therapy.


The proportion of patients treated with an OAC ranged from 9-86%, with a median of 24%. The proportion of patients treated with an antiplatelet agent ranged from 10-59%, with a median of 42%. The proportion of untreated patients ranged from 4-69%, with a median of 23%. The proportion of patients receiving an OAC increased from 10% in 1982 to approximately 60% in 2007. The proportion of patients treated with an OAC was 37% in low-risk patients, 45% in moderate-risk patients, and 58% in high-risk patients.


The authors concluded that approximately 50-60% of moderate- and high-risk patients with AF are not treated with an OAC.


This review highlights the underutilization of OACs that has been well-documented in multiple studies. Although the specific reasons for this underutilization are unclear, it is likely that the inconvenience of warfarin therapy plays an important role. Newer OACs such as dabigatran do not require titration based on monitoring of a blood test and are not associated with the dietary restrictions imposed by warfarin usage. It remains to be seen whether the recent introduction of dabigatran into clinical practice will improve compliance with treatment guidelines.

Clinical Topics: Anticoagulation Management, Novel Agents

Keywords: Benzimidazoles, Warfarin, Hematologic Tests

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