The role of contraindications in prescribing anticoagulants to patients with atrial fibrillation: a cross-sectional analysis of primary care data in the UK

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Abstract

Background: Underuse of anticoagulants in atrial fibrillation (AF) is an international problem which has often been attributed to the presence of contraindications to treatment. No studies have assessed the influence of contraindications on anticoagulant prescribing in the UK.

Aim: To determine the influence of contraindications on anticoagulant prescribing in AF patients in the UK.

Design and setting: Cross-sectional analysis of primary care data from 645 general practices contributing to The Health Improvement Network (THIN), a large UK database of electronic primary care records.

Methods: 12 sequential cross-sectional analyses were carried out from 2004 to 2015. Patients with a diagnosis of AF aged 35 years and over and registered for at least one year were included. Outcome measure was prescription of anticoagulant medication.

Results: Over the 12 study years, the proportion of eligible AF patients with contraindications prescribed anticoagulants increased from 40.1% (95%CI 38.3, 41.9) to 67.2% 95%CI 65.6, 68.8), and among those without contraindications from 42.1% (95%CI 41.6, 42.6) to 67.7% (95%CI 67.2, 68.1). In patients with a recent history of major bleeding or aneurysm, prescribing rates increased from 44.3% (95%CI 42.2, 46.5) and 34.8% (95%CI 29.4, 40.6) in 2004 to 71.7% (95%CI 69.9, 73.5) and 63.2% (95%CI 58.3, 67.8) in 2015 respectively, comparable to rates in patients without contraindications.

Conclusion: The presence or absence of recorded contraindications has little influence on the decision to prescribe anticoagulants for the prevention of stroke in AF patients. Nationally, 38,000 AF patients with contraindications are treated with anticoagulants.
Original languageEnglish
Pages (from-to)e588-e597
JournalBritish Journal of General Practice
Volume67
Issue number662
Early online date19 Jun 2017
DOIs
Publication statusPublished - Sep 2017

Keywords

  • anticoagulants
  • general practice
  • Atrial fibrillation
  • contraindications
  • stroke prevention
  • treatment

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