FACTORS ASSOCIATED WITH UNDER UTILIZATION OF ANTICOAGULATION IN PATIENTS WITH ATRIAL FIBRILLATION WITH HIGH RISK PROFILE FOR THROMBOEMBOLISM

OBJECTIVE: To determine the factors associated with under utilization of anticoagulation in patients with atrial fibrillation (AF) with high risk profile for thromboembolism. METHODS: This descriptive cross-sectional study was conducted at Cardiovascular Department Lady Reading Hospital Peshawar, Pakistan and Cardiology Department Hayatabad Medical Complex Peshawar, Pakistan from 01-12-2014 to 28-02-2015. All patients visiting OPD of respective hospitals with electrocardiogram (ECG) evidence of AF and CHADS VASC score 2 or more and mitral stenosis and AF were included. RESULTS: Out of 205 patients, 114 (55.6%) were males and mean age was 60.7±4.7 years. Out of 205, 149 (72.7%) were candidates for anticoagulation. AF patients with CHA2DS2 VASc score of ≥2 were 130 while patients with mitral stenosis and AF were 19. Only 41(27.5%) patients were adequately treated with anticoagulant therapy using vitamin K antagonist (VKA) or novel oral anticoagulant drugs. Factors associated with underutilization of anticoagulant therapy were, patient preference 27.8%, older age of 65 and above 17.6%, use of dual antiplatelet therapy 28.7 %, monitoring issue 9.3%, affordability 8.3% and prior complications due to anticoagulation therapy in 8.3%. CONCLUSION: Patients refusal of taking anticoagulation therapy, poverty, older age, lack of monitoring facility, previous complications or use of anti-platelet therapy are major causes of under utilization of anticoagulant therapy in patients with AF.