Just Say No to Anticoagulation for These Patients With Atrial Fibrillation

May 1, 2015

Guidelines say “no” to anticoagulation for young, otherwise healthy persons with atrial fibrillation. New research finds that clinical practice looks quite different.

Patients with atrial fibrillation (AF) who are at low risk for thromboembolism are poor candidates for oral anticoagulation (OAC) because the bleeding risk outweighs any potential benefit. In fact, guidelines recommend against OAC in AF patients younger than 60 years and in AF patients who have no other risk factor for stroke.An analysis of AF patients in the National Cardiovascular Data Registry’s (NCDR) Practice Innovation and Clinical Excellence (PINNACLE) Registry found that theory, even when evidence-based, does not always translate into clinical practice. The slides above summarize insights from the analysis, including the prevalence of OAC prescribing for young healthy patients with AF and clinical predictors of the practice. References Hsu JC, Chan PS, Tang F, et al. Oral anticoagulant prescription in patients with atrial fibrillation and a low lisk of thromboembolism: Insights From the NCDR PINNACLE Registry. JAMA Intern Med. Published online April 13, 2015. doi:10.1001/jamainternmed.2015.0920.January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014;130:2071-2104. Lip GH, Skjøth F, Rasmussen L, Larsen T. Oral anticoagulation, aspirin, or no therapy in patients with nonvalvular AF with 0 or 1 stroke risk factor based on the CHA2DS2-VASc Score. J Am Coll Cardiol. 2015;65:1385-1394. doi:10.1016/j.jacc.2015.01.044.