Abstract
Atrial fibrillation is a common atrial tachyarrhythmia with an increased risk of thromboembolism. This study aims to provide information about the application of antithrombotic treatment based on risk stratification schemes for stroke in real-life clinical practices. This was a descriptive cross-sectional study in 260 patients admitted at the tertiary care hospital with a diagnosis of atrial fibrillation from January 2019 to February 2020 after approval from the Institutional Review Committee (ref. no. 207/2018). Convenient sampling was used. Predisposing conditions for atrial fibrillation, risk factors for stroke, and the use of antithrombotics were obtained based on the pre-structured questionnaires. Data were analyzed by Statistical Package for the Social Sciences version 20. The prevalence of valvular and non-valvular atrial fibrillation was 125 (48.0%), and 135 (51.9%) respectively. Among patients with a non-valvular variant, 102 (75.5%) had a CHA2DS2VASc-score of ≥2 who were eligible for oral anticoagulants, 13 (9.6 %) patients received it with a majority having sub-therapeutic international normalized ratio. Among patients with valvular type, only 47 (37.6%) patients were receiving oral anticoagulants and 20 (42.5%) patients achieved therapeutic international normalized ratio. Two hundred forty three (93.4%) patients had dilated left atrium (≥40mm), 119 (45.9%) had hypertension and 27 (10.3%) had diabetes mellitus. Antithrombotics were markedly underused in patients with atrial fibrillation. There is a need for proper application of risk stratification schemes for stroke and appropriate use of antithrombotics to prevent thromboembolism.
Highlights
Atrial fibrillation is a common atrial tachyarrhythmia with an increased risk of thromboembolism
This study has shown the underuse of antithrombotic therapy in the form of either oral anticoagulants (OACs) or antiplatelet agents in patients with both valvular atrial fibrillation (VAF) and NVAF according to contemporary international guidelines
A study done in a rural part of Nepal by the same author showed that 39.1% of patients with NVAF who had a CHA2DS2 score of > 2 and eligible for oral anticoagulants, only 18.9 % of patients received it
Summary
Atrial fibrillation is a common atrial tachyarrhythmia with an increased risk of thromboembolism. This study aims to provide information about the application of antithrombotic treatment based on risk stratification schemes for stroke in real-life clinical practices. Atrial fibrillation (AF) is the most common sustained tachyarrhythmia which affects 1-2% of the general population.. AF is a risk factor for stroke and thromboembolism. Stroke prevention is a major concern when managing patients with AF. Various clinical risk factors have been identified, which confer a high risk of stroke. An important aspect of AF management is the prevention of stroke, using antithrombotic agents including anti-platelets and oral anticoagulants (OACs).. The literature provides simplified rules for the use of antithrombotic in patients with AF, studies have shown that OAC is frequently underused in AF patients with reported use in between 30 and 60%.1,3,4 An important aspect of AF management is the prevention of stroke, using antithrombotic agents including anti-platelets and oral anticoagulants (OACs). the literature provides simplified rules for the use of antithrombotic in patients with AF, studies have shown that OAC is frequently underused in AF patients with reported use in between 30 and 60%.1,3,4
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