Implementation of antithrombotic management in atrial fibrillation
S J McNulty, D Hutchinson, K J Hardy
Department of
Medicine, Whiston Hospital, Prescot, Merseyside L35 5DR, UK
Correspondence to: Dr Steven McNulty, Specialist Registrar in General Internal Medicine, Endocrinology and Diabetes, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK sid{at}doctors.org.uk
Submitted 25 January
2000;
Accepted 4 April 2000
The aim of the study was to assess the extent to which
published recommendations on the antithrombotic management of atrial fibrillation had been adopted into clinical practice in a busy district
general hospital, and the impact of clinical audit on subsequent
management. In the initial audit, 185 consecutive patients with atrial
fibrillation were studied using their case notes to identify any
further clinical risk factors for stroke. A management algorithm
stratified patients with atrial fibrillation into high, moderate, or
low risk of stroke according to the individual stroke risk factors. For
patients at high risk, the correct treatment is warfarin unless there
are specific contraindications. For patients at moderate risk, the
correct management is aspirin unless there are specific
contraindications. Patients at low risk should receive no
thromboprophylaxis. The clinical risks of stroke and thromboprophylaxis on discharge from hospital were recorded. An extensive education programme on stroke prevention in atrial fibrillation was undertaken. Six months later a further 185 consecutive patients with atrial fibrillation were audited. Overall, a large proportion (306/370; 83%)
of patients were at high risk of stroke. In the initial audit, antithrombotic management was correct in 89 patients (48%). In the
follow up audit, antithrombotic management was correct in 135 patients
(73%) (p < 0.00001). If this improvement in management were
extrapolated to all hospital patients in the United Kingdom, approximately 1400 strokes/year could be avoided. Despite broad consensus in recent publications, antithrombotic management of atrial fibrillation remains imperfect, with many patients exposed to
unnecessarily high risk of stroke.
Keywords: atrial fibrillation; anticoagulation
© 2000 by The Fellowship of Postgraduate Medicine
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
-
Jackson, S. L, Peterson, G. M, Vial, J. H
(2004). A Community-Based Educational Intervention to Improve Antithrombotic Drug Use in Atrial Fibrillation. The Annals of Pharmacotherapy
38: 1794-1799
[Abstract] [Full Text] -
Ezekowitz, M. D., Falk, R. H.
(2004). The Increasing Need for Anticoagulant Therapy to Prevent Stroke in Patients With Atrial Fibrillation. Mayo Clin Proc.
79: 904-913
[Abstract] -
CONWAY, D S G, LIP, G Y H
(2001). Anticoagulation and atrial fibrillation. Postgrad. Med. J.
77: 487-487
[Full Text] -
LAIRIKYENGBAM, S K S, DAVIES, A G, JONES, P D
(2001). Implementation of antithrombotic management in atrial fibrillation. Postgrad. Med. J.
77: 488-488
[Full Text] -
MURPHY, P T, CASEY, M C
(2001). Improvement in antithrombotic management in atrial fibrillation also requires effective INR control. Postgrad. Med. J.
77: 487a-488
[Full Text]
- Full Text
- Full Text (PDF)
- Submit a response
- Alert me when this article is cited
- Alert me when eLetters are posted
- Alert me if a correction is posted
- Citation Map
Services
- Email this link to a friend
- Similar articles in this journal
- Similar articles in PubMed
- Add article to my folders
- Download to citation manager
- Request Permissions
Citing Articles
Google Scholar
PubMed
Topic Collections
Bookmark with
Register for free content
The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.
Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.
