Skip to main content
SpringerLink
Log in

Atrial Fibrillation and Antithrombotic Treatment in Italian Hospitalized Patients: A Prospective, Observational Study

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

Background: We studied the prevalence of atrial fibrillation within a large Italian inpatient population, and evaluated the use of antithrombotic therapy among these individuals.

Methods: A prospective cross sectional study (Phase 1) with a 1-year follow-up period (Phase 2) was conducted at a single Italian centre. During Phase 1, we conducted a chart review of all inpatients on 5 separate days, each 1 month apart, between January and May 1999. During Phase 2, at 1-year of follow-up, patients or their families were contacted to document the occurrence of new clinical events, as well as current antithrombotic therapy use.

Results: A total of 3121 patient charts were reviewed. The prevalence of atrial fibrillation was 7.2%. Of these 224 patients, 21.3% were on oral anticoagulants, 29.7% on antiplatelets, while 49% received neither. Patients on oral anticoagulants were significantly younger (mean age 72.3 years) than those on antiplatelets (mean age 80.6 years; p<0.001) or neither therapy (mean age 80.7 years; p<0.001). At 1 year follow up, an acute ischaemic stroke occurred among 7.4% of the 121 contacted patients. Among patients with chronic atrial fibrillation [98], 25.5% were receiving an oral anticoagulant.

Conclusions: Despite clear evidence from clinical trials, oral anticoagulants are significantly underused among patients with chronic atrial fibrillation. Methods should be developed to improve both physician and patient knowledge about the overall benefits of anti-thrombotic therapy among these individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: The Framingham Study. Stroke 1991;22:983-988.

    PubMed  Google Scholar 

  2. Aronow WS, Ahn C, Gutstein H. Prevalence of atrial fibrillation and association of atrial fibrillation with prior and new thromboembolic stroke in older patients. J Am Geriatr Soc 1996; 44:521-523.

    Google Scholar 

  3. Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch Intern Med 1994;154:1449-1457.

    Google Scholar 

  4. Hart RG, Benavente O, McBride R, Pearce LA. Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Ann Intern Med 1999;131:492-501.

    PubMed  Google Scholar 

  5. Laupacis A, Albers G, Dalen J, Dunn MI, Jacobson AK, Singer DE. Antithrombotic therapy in atrial fibrillation. Chest 1998;114:579S-589S.

    PubMed  Google Scholar 

  6. Lip GYH. Thromboprophylaxis for atrial fibrillation. Lancet 1999;353:4-6.

    PubMed  Google Scholar 

  7. Albers GW, Yim JM, Belew KM, Bittar N, Hattemer CR, Phillips BG, et al. Status of antithrombotic therapy for patients with atrial fibrillation in university hospital. Arch Intern Med 1996;156: 2311-2316.

    Article  Google Scholar 

  8. Stafford RS, Singer DE. National patterns of warfarin use in atrial fibrillation. Arch Intern Med 1996;156:2537-2541.

    Article  Google Scholar 

  9. Whittle J, Wickenheiser L, Venditti LN. Is warfarin underused in the treatment of elderly persons with atrial fibrillation? Arch Intern Med 1997; 157:441-445.

    Article  Google Scholar 

  10. Munchauser FE, Priore RL, Hens M, Castilone A. Thromboembolism prophylaxis in chronic atrial fibrillation. Practice patterns in community and tertiarycare hospitals. Stroke 1997;28:72-76.

    Google Scholar 

  11. Brass LM, Krumholz HM, Scinto JM, Radford M. Warfarin use among patients with atrial fibrillation. Stroke 1997;28:2382-2389.

    Google Scholar 

  12. Sudlow M, Thomson R, Thwaites B, Rodgers H, Kenny RA. Prevalence of atrial fibrillation and eligibility for anticoagulants in the community. Lancet 1998; 352:1167-1171.

    Article  PubMed  Google Scholar 

  13. Brass LM, Krumholz HM, Scinto JD, Mathur D, Radford M. Warfarin use following ischemic stroke among medicare patients with atrial fibrillation. Arch Intern Med 1998;158:2093-2100.

    Article  PubMed  Google Scholar 

  14. Gage BF, Boechler M, Doggette AL, Fortune G, Flaker GC, Rich MW, et al. Adverse outcomes and predictors of underuse of antithrombotic therapy in medicare beneficiaries with chronic atrial fibrillation. Stroke 2000;31:822-827.

    PubMed  Google Scholar 

  15. Cortelazzo S, Finazzi G, Viero P, Galli M, Remuzzi A, Parenzan L, et al. Thrombotic and hemorragic complications in patients with mechanical heart valve prosthesis attending an anticoagulation clinic. Thromb Haemost 1993;69:316-320.

    PubMed  Google Scholar 

  16. Taylor F, Ramsay M. GPs not prepared for monitoring anticoagulation. BMJ 1993;307:1493.

    Google Scholar 

  17. McCrory DC, Matchar DB, Samsa G. Physicians attitudes about anticoagulation for nonvalvular atrial fibrillation in the elderly. Arch Intern Med 1995;155: 277-281.

    Article  PubMed  Google Scholar 

  18. Chiquette E, Amato MG, Bussey HI. Comparison of an anticoagulation clinic with usual medical care: Atrial Fibrillation and Prophylaxis in Italian Inpatients 229 anticoagulation control, patient outcomes, and health care costs. Arch Intern Med 1998;158:1641-1647.

    Article  PubMed  Google Scholar 

  19. Barcellona D, Contu P, Sorano GG, Pengo V, Marongiu F. The management of oral anticoagulant therapy: the patient's point of view. ThrombHaemost 2000;83:49-53.

    Google Scholar 

  20. Palareti G, Leali N, Coccheri S, Poggi M, Manotti C, D'Angelo A, et al. Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT). Lancet 1996;348:423-428.

    Article  PubMed  Google Scholar 

  21. Fihn SD, Callahan CM, Martin DC, McDonnell MB, Henikoff JG, White RH. The risk for and severity of bleeding complications in elderly patients treated with warfarin. Ann Intern Med 1996;124:970-979.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical and Biological Sciences, University of Insubria, Ospedale di Circolo di Varese, Viale Borri 57, 21100, Varese, Italy

    Walter Ageno MD, Fabio Ambrosini MD, Barbara Nardo MD, Daniela Imperiale MD, Francesco Dentali MD, Valentina Mera MD, Roberto Cattaneo MD, Elena Barlocco MD, Luigi Steidl MD & Achille Venco MD

Authors
  1. Walter Ageno MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabio Ambrosini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Barbara Nardo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniela Imperiale MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francesco Dentali MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Valentina Mera MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Roberto Cattaneo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Elena Barlocco MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Luigi Steidl MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Achille Venco MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ageno, W., Ambrosini, F., Nardo, B. et al. Atrial Fibrillation and Antithrombotic Treatment in Italian Hospitalized Patients: A Prospective, Observational Study. J Thromb Thrombolysis 12, 225–230 (2001). https://doi.org/10.1023/A:1015223024268

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1015223024268

Search

Navigation