Atrial Fibrillation and Oral Anticoagulation : The Importance of Guideline-Adherence and Clarity Hestvik, Lukas
Atrial fibrillation (AF) is the most prevalent arrhythmia, affecting 350,000 Canadians. AF can impact quality of life, mortality, and morbidity. The most serious complication of AF is thrombo-embolic stroke, and is responsible for 20 to 30% of all strokes. Oral anticoagulation (OAC) of AF can decrease the risk of stroke by 64%. Risk stratification tools have been developed and incorporated into guidelines to assist practitioners in providing the most appropriate OAC treatment for each individual patient. However, research has indicated that there is a lack of adherence by practitioners to guideline-based oral anticoagulation therapy. Until recently, warfarin was the anticoagulant of choice for nonvalvular AF. Warfarin is inexpensive, widely available, and also has the benefit of having widely available reversal agents. More recently, direct oral anticoagulants (DOACs) have been approved for the treatment of nonvalvular AF. In clinical trials DOACs have demonstrated to be as safe and effective in preventing strokes compared to warfarin if not more. They are also more convenient for patients as they have much fewer drug and food interactions and do not require rigorous routine blood monitoring. However, DOACs are more expensive than warfarin and previously did not have reversal agents available. Dabigatran (a DOAC), now has a reversal agent, and other reversal agents are being developed for the rest of the DOACs. In this paper, I will review three guidelines for oral anticoagulation treatment in nonvalvular AF. I will discuss potential reasons for practitioners’ lack of adherence to these guidelines. And finally, I will explain the pocket guide that I will create to assist new practitioners in treating AF. By summarizing different guidelines into one pocket guide, I will assist new practitioners in having the richest source of information in one location, as opposed to having to consult different guidelines and potentially AF and OAC becoming confused as to what is best practice. The ultimate goal of this project is to decrease the number of AF-induced strokes.
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