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Stroke prevention and atrial fibrillation: reasons leading to an inappropriate management. Main results of the SAFE II study

Article date: June 2004

By: Dominique Deplanque, Didier Leys, Lucilla Parnetti, Reinhold Schmidt, Jose Ferro, Jacques De Reuck, Jean‐Louis Mas, Virgilio Gallai, the SAFE ll Investigators in Volume 57, Issue 6, pages 798-806

Aims  The aim of the Stroke and Atrial Fibrillation Ensemble (SAFE) II study was to identify the reasons underlying the under‐utilization of oral anticoagulation (OAC) in patients with nonvalvular atrial fibrillation (NVAF).

Methods  We investigated from all available sources the reasons why patients hospitalized for a stroke, who had a previously known NVAF, were not receiving OAC beforehand. We interviewed general practitioners (GPs) and cardiologists with a structured questionnaire, to identify the reasons for their therapeutic choice.

Results  Of 370 patients, 257 were theoretically eligible for OAC according to guidelines and the presence of contra‐indications, but only 82 (22.2%) of them had actually received OAC before. We found that factors independently associated with the prescription of OAC were being followed‐up by a cardiologist and having a younger GP. The leading reason evoked by GPs or cardiologists to explain why patients were not treated with OAC was the presence of a ‘potential contra‐indication’, which was often inappropriate, followed by ‘there was no indication’, ‘low compliance’ and ‘fear of bleeding’.

Conclusions  An important reason for not prescribing OAC was the lack of knowledge about trials and guidelines. Medical education about OAC in NVAF should therefore be improved.

DOI: 10.1111/j.1365-2125.2004.02086.x

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