Predictors of Oral Anticoagulants Utilization in Patients with Atrial Fibrillation

Abstract

Introduction: Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance, increasing in prevalence with age. It is often associated with structural heart disease, although a substantial proportion of patients with AF have no detectable heart disease. Hemodynamic impairment and thromboembolic events related to AF result in significant morbidity, mortality, and cost. Several factors are associated with the prescription of oral anticoagulants. This review predicts the overall factors that are associated with oral anticoagulant utilization in patients with AF.

Methods: Literatures that analyze the predictors of oral anticoagulant utilization in atrial fibrillation were searched using PubMed and Google Scholar published in journals from 2003 to 2019. Eligibility, data extraction and quality assessment were followed by a narrative synthesis of data. An extensive search of recent literature was performed.

Results: Older age, comorbidities like hypertension, diabetes, heart failure, coronary artery disease, peripheral artery disease, moderate to severe kidney disease, polypharmacy, higher stroke and bleeding risk, history of smoking and alcohol or substance abuse, and lower cost are predictors of warfarin utilization. Similarly, younger age, better kidney function with creatinine clearance at least 30 mL/min, no or lower risk of stroke and hemorrhage, no polypharmacy, less comorbidities, prescriptions by neurologists and cardiologist, people residing in countries with lower poverty rates, and high cost are potential predictors of non-vitamin K antagonist oral anticoagulants utilization.

Conclusion: Our study suggests that knowing the predictors for anticoagulation utilization can improve medication appropriateness in arterial fibrillation patients.