Blood Thinners Unnecessary For AP Patients With Low Stroke Risk

New findings published in JAMA Internal Medicine show that about a quarter of all atrial fibrillation (AF) patients at the lowest risk for stroke receive unnecessary blood thinners from cardiology specialists that could result in added health issues.

"The irony is that there is a general push to get providers to prescribe these drugs, and they are also generally under-prescribed among many AF patients who actually need them," said senior author Gregory Marcus, MD, MAS, director of clinical research in the UCSF Division of Cardiology, in a news release. "Our study suggests people are trying to do the right thing but, due to a lack of understanding of some of the critical nuances, go too far in that direction in low-risk patients."

For patients dealing with AF, the upper chambers (atria) of the heart are triggered by electrial impulses in and around the surface area instead of just one area. The chaotic activity and the atrial walls will begin to quiver instead of properly contract, moving the blood to the lower chambers (ventricles.)

For patients at risk of thromboembolism, anticoagulation therapies with warfarin or other drugs can reduce morbidity and mortality risk. However, there is a bleeding risk that is not recommended for AF patients with low stroke risk.

Furthermore, current guidelines recommend oral anticoagulation in patients under age 60 without heart disease or other known risk factors for thromboembolism or in AF patients without any established stroke factor risk.

Researchers examined the prevalence of non-guideline adhering oral anticoagulant prescriptions in young and healthy patients at the lowest risk for thromboembolism via 11,000 patients nationwide 60 and under who were part of the overall Practice Innovation and Clinical Excellence (PINNACLE) Registry® of the National Cardiovascular Data Registry between 2008-2012. The PINNACLE Registry was created in 2008 by the American College of Cardiology as the first national, prospective, office-based cardiac quality improvement registry in the United States and enrolled more than 1.7 million patients.

Findings revealed that about 25 percent of patients (2,561) were prescribed oral anticoagulant therapy contrary to health guidelines. Males with AF at lowest risk for stroke were also more likely to be prescribed oral anticoagulation than females; the same was true for older patients and overweight patients with stroke risk factors.

At this time, the study authors believe that some may not be completely aware of the potential risks associated with these drugs, particularly for low stroke risk patients.

"Practitioners who prescribe blood thinners need to be diligent about weighing the risks and benefits of these medications," concluded lead study author Jonathan C. Hsu, MD, MAS, of the UC San Diego Division of Cardiology and recent UCSF cardiology and electrophysiology graduate. "In those patients with no risk factors for stroke, the risk of bleeding likely outweighs the benefit of stroke reduction. The fact that blood thinners were prescribed to so many patients with no risk factors for stroke is a wake up call that we need to do better for our patients."

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