Anticoagulant Therapy for Non- Valvular Atrial Fibrillation Patients, How Close Are We to the Guidelines?

الملخص

Atrial Fibrillation (A-fib) is strongly associated with cerebrovascular accident CVA, transient ischemic attacks, and peripheral
vascular embolic events, oral anticoagulants are widely prescribed for the prevention of these events associated with AF.
The study aimed to assess the adherence of physicians providing care to A-fib patients with the European Society of Cardiology
(ESC) guidelines of (A-fib) treatment regarding anticoagulation therapy.
This audit was carried out with a case series design by reviewing the medical records and discharge papers of 100 Libyan
patients diagnosed with Non-Valvular atrial fibrillation (NVAF) who were admitted to the cardiology department at Tripoli
University Hospital from (Jan - Dec 2021).
The files of 100 Libyan patients with NVAF were evaluated 60 were females (60%), the mean age was 65.6 ± 14 years, 57%
were elderly older than 65 yrs. 32% live outside Tripoli. Regarding the cause of A-fib, ischemic heart disease (IHD) was the
commonest cause 37%, hypertension 36%, Non Ischemic cardiomyopathy 22%. Regarding the other comorbidities, diabetes
mellitus was found in 44% of patients, History of cerebrovascular accident (CVA) was documented for 17% of patients. Anti -arrhythmic drugs were prescribed for 75.4% of patients at discharge; Antiplatelet drugs (Aspirin and clopidogrel) were prescribed
for 27% of the patients, Anticoagulants were prescribed for 57 patients (57%) at discharge, warfarin in 83.3% of them and Direct
Oral Anticoagulant (DOACs) in the form of Rivaroxaban (Xarelto) in 16.7%. and no anticoagulant prescribed to the other 43
patients (43%), 40 patients of them (93%) were with CHA2DS2-VA score≥2 which according to the new ESC guidelines of
the management of AF they recommended to be on oral anticoagulants, from these 40 patients; Aspirin prescribed to 14 (35%),
Aspirin and clopidogrel prescribed to 13 (32.5%) and the other 13 patients (32.5%%) discharged with no anticoagulant nor anti
platelets, with no clear cause documented in the medical records.
Conclusion: 40% of the patients under study were discharged without a prescription of any anticoagulant, although they were
fulfilling the ESC guideline of AF treatment.
Recommendation: additional study on the knowledge, attitude, and practice of physician about the importance of anticoagulants
in preventing thromboembolic complications in A-fib patients.