OBJECTIVE: To determine the factors associated with under utilization
of anticoagulation in patients with atrial fibrillation (AF) with high risk
profile for thromboembolism.
METHODS: This descriptive cross-sectional study was conducted at
Cardiovascular Department Lady Reading Hospital Peshawar, Pakistan
and Cardiology Department Hayatabad Medical Complex Peshawar,
Pakistan from 01-12-2014 to 28-02-2015. All patients visiting OPD of
respective hospitals with electrocardiogram (ECG) evidence of AF and
CHADS VASC score 2 or more and mitral stenosis and AF were included.
RESULTS: Out of 205 patients, 114 (55.6%) were males and mean age
was 60.7±4.7 years. Out of 205, 149 (72.7%) were candidates for anticoagulation. AF patients with CHA2DS2 VASc score of ≥2 were 130
while patients with mitral stenosis and AF were 19. Only 41(27.5%)
patients were adequately treated with anticoagulant therapy using
vitamin K antagonist (VKA) or novel oral anticoagulant drugs. Factors
associated with underutilization of anticoagulant therapy were, patient
preference 27.8%, older age of 65 and above 17.6%, use of dual antiplatelet therapy 28.7 %, monitoring issue 9.3%, affordability 8.3% and prior complications due to anticoagulation therapy in 8.3%.
CONCLUSION: Patients refusal of taking anticoagulation therapy,
poverty, older age, lack of monitoring facility, previous complications
or use of anti-platelet therapy are major causes of under utilization of
anticoagulant therapy in patients with AF.
KEY WORDS: Atrial Fibrillation (MeSH), CHADS VASC score 2 (NonMeSH), Dual Antiplatelet Therapy (DAPT) (Non-MeSH), Warfarin
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