Many With AFib Miss Out on Blood Thinners
Less than half at highest risk take recommended blood-thinning medication, study finds
By Alan Mozes
WEDNESDAY, March 16, 2016 (HealthDay News) -- Doctors know that a heart rhythm disorder called atrial fibrillation increases the odds for stroke. But less than half of "a-fib" patients at highest risk for stroke are prescribed recommended blood thinners by their cardiologists, new research finds.
"The findings of our study are surprising given that these patients with atrial fibrillation were treated by a cardiovascular specialist, who should be aware of guideline recommendations" for anticoagulants, such as warfarin, said study lead author Dr. Jonathan Hsu. He is a cardiologist and assistant professor of medicine at the University of California, San Diego.
Hsu's team tracked more than 400,000 atrial fibrillation patients in the United States for four years. The investigators found that most were prescribed blood-thinning drugs up to a point. But more than 50 percent of the very highest-risk patients leave their doctor's office without a prescription for potentially life-saving blood thinners.
Whether their doctors are ignoring or misinterpreting treatment guidelines isn't clear, he said.
"As with many issues in medicine, there are likely several reasons," Hsu suggested.
Part of the problem could simply be "patient preference," he said. On the other hand, cardiologists may place too much emphasis on the risk for bleeding that blood thinners pose. But for most patients the benefits are worth the risk, Hsu said.
The study findings are published in the March 16 online edition of JAMA Cardiology.
Atrial fibrillation -- characterized by electrical irregularities that prompt the upper chambers of the heart to function abnormally -- can boost the risk for blood clotting and stroke fivefold, experts say.
One-quarter of all Americans over age 40 are at risk for developing atrial fibrillation at some point in their lives, the study authors noted.
In addition to warfarin (Coumadin), prescribed blood thinners in the United States include Pradaxa (dabigatran), Xarelto (rivaroxaban) and Eliquis (apixaban).
Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said there is overwhelming evidence that blood thinners benefit atrial fibrillation patients at moderate to high risk of stroke.