Original Article

Clinical Correlation Between Effective Anticoagulants and Risk of Stroke: Are We Using Evidence-based Strategies?

Authors: Ali R. Rahimi, MD, Bobby Wrights, MD, Hossein Akhondi, MD, Christian M. Richard, MSC

Abstract

Objectives: Despite evidence supporting anticoagulant use in atrial fibrillation, this modality is not fully utilized.


Methods: Retrospective chart review of 297 patients with nonvalvular atrial fibrillation between 1997 to 2000. 124 patients received warfarin and 166 did not; 91 patients suffered stroke.


Results: Age (P = 0.232) and gender (P = 0.745) were not determinant factors for starting anticoagulation prophylaxis. Whites were more likely to receive anticoagulation therapy than blacks (P = 0.043). Cardiologists were 4.5 times more likely to prescribe warfarin than neurologists and internists (P = 0.035). Neurologists (P = 0.305) and internists (P = 0.770) had similar warfarin prescription patterns and often with patients experiencing the highest rates of stroke.


Conclusion: Lack of a uniform pattern in anticoagulant administration, despite multiple guidelines, is disturbing. Continuous physician education and community awareness by local and federal medical agencies is essential and cost-effective.


Key Points


* Despite evidence supporting the use of anticoagulation therapy in atrial fibrillation, this modality is not fully utilized.


* Physicians with different specialties have different patterns of prescribing anticoagulants.


* Costs and fear of complications appear to be among the factors influencing anticoagulant prescriptions.


* Additional educational efforts would be both timely and cost-effective.

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