Characterization of patients with atrial fibrillation not treated with oral anticoagulants
Sammanfattning
Objective. An underuse of oral anticoagulants (OAC) in patients with atrial fibrillation (AF) has
been suggested, as only 50% of all patients with AF receive OAC treatment. Whether this is due to
contraindications, lack of an indication to treat, or an expression of underuse is sparsely
investigated. This study therefore aimed to characterize individuals without OAC treatment in a real-
life population of patients with AF. Design. Retrospective cross-sectional study. The medical records
were scrutinized in order to identify the type of AF, risk factors for embolism and bleeding, and other
factors of importance for OAC treatment. Setting. The municipalities of Skellefteå and Norsjö, northern
Sweden. Subjects. A total of 2274 living residents with at least one verified episode of AF on or before
December 31, 2010. Main outcome measures. Prevalence of treatment with OAC and documented
reasons to withhold OAC treatment. Results. Among all 2274 patients with AF, 1187 (52%) were not
treated with OAC. Of the untreated patients, 19% had no indication or had declined or had experienced
adverse effects other than bleeding on warfarin treatment. The most common reason to withhold OAC
was presence of risk factors for bleeding, found in 38% of all untreated patients. Furthermore, a
documented reason could be identified to withhold OAC in 75%. Conclusions. Among patients with AF
without OAC treatment a reason could be identified to withhold OAC in 75%. The underuse of OAC is
estimated to be 25%.