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OAC underutilised in patients with AF

Oral anticoagulant (OAC) use in patients with atrial fibrillation (AF) has increased in UK practice since 2007, but remains suboptimal in current practice, according to a study1 published recently in the British Journal of General Practice.

Researchers conducted a cross-sectional survey of 583 UK practices linked to the QResearch® database, providing 99,351 anonymised electronic records from people with AF. Their aim was to measure the distribution of stroke risk in patients with AF using the CHADS2 and CHA2DS2-VASc scores, and assess changes in OAC use during 2007–2010.

The proportion of patients in each CHADS2 and CHA2DS2-VASc risk band in 2010 was calculated; for each of the years 2007–2010, the proportions with risk scores ≥2 that were using anticoagulants or antiplatelet agents were estimated. The proportions identified at high risk were re-estimated using alternative definitions of hypertension based on coded data. Finally, the prevalence of comorbid conditions in treated and untreated high-risk (CHADS2 ≥2) groups was derived.

Only 53.0% of patients in the study at high risk of stroke were found to be using oral anticoagulants. This proportion increased only slightly in the years 2007–2010. At the same time, higher than expected usage was found in the low-risk groups: 32.1% of people with CHADS2 = 0 and 23.0% with CHA2DS2VASc = 0. “While anticoagulation may be appropriate for some of these individuals, this suggests that use of these algorithms has still to become established,” the authors say.

They also assert that improved coding of hypertension is required to support systematic identification of individuals at high risk of stroke, “and could be assisted by practice-based software”.


1. Holt TA, Hunter TD, Gunnarsson C, Khan N, Cload P and Lip GYH. Risk of stroke and oral anticoagulant use in atrial fibrillation: a cross-sectional survey. Br J Gen Pract 2012.

Published on: November 15, 2012

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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