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 Researchers studied almost 430,000 people with a condition known as
atrial fibrillation, an irregular rapid heartbeat that can lead to
stoke, heart failure and chronic fatigue.
More than half of the atrial fibrillation patients at the highest
risk of stroke didn’t get prescriptions for blood thinners – also
called anticoagulants – the study found. Most strokes occur when a
clot blocks a blood vessel supplying the brain; blood thinners can
prevent clots from forming or stop existing clots from getting
bigger.
“We have identified a continued treatment gap in patients with
atrial fibrillation at risk for stroke,” said lead study author Dr.
Jonathan Hsu, a heart specialist at the University of California,
San Diego.
“Our study should act as a wake-up call – we as practitioners and
patients need to be aware of the stroke risk that exists with atrial
fibrillation and find ways to do better in treating at-risk patients
with potentially life-saving oral anticoagulants,” Hsu added by
email.
In atrial fibrillation, electrical impulses in the upper chambers of
the heart are chaotic, and the atrial walls quiver rather than
contract normally in moving blood to the lower chambers. This can
lead to the formation of clots, and atrial fibrillation patients
have up to seven times the stroke risk of people without the
disorder.
To see how many atrial fibrillation patients receive needed pills to
avert clots, Hsu and colleagues reviewed medical and prescription
data collected from 2008 to 2012 in a national registry of people
with cardiovascular disease.
The patients were 71 years old on average and about 56 percent were
men.
Overall, 45 percent of them received blood thinners, researchers
report in JAMA Cardiology.
Another 31 percent of the patients took aspirin, which can reduce
the risk of strokes by preventing platelets in the blood from
attaching to debris on blood vessel walls and can also lead to
clots. Some of the people on aspirin paired it with anti-platelet
medications known as thienopyrdine.
Roughly one in four patients took no medication at all to avoid
clots or strokes.
Side effects may partly explain the limited use of blood thinners.
Long-term use of the blood thinner warfarin (Coumadin, Jantoven) can
increase the risk of severe bleeding, and it’s inconvenient because
it requires frequent lab tests and check-ups to ensure that patients
have the right dose.
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One limitation of the study is that researchers lacked data on
whether patients had medical reasons that would prevent their use of
blood thinners, the authors note. People with conditions that can
increase the risk of bleeding problems – like high blood pressure,
cancer, kidney problems or alcoholism – might not be able to take
warfarin.
Another shortcoming is that they assessed blood thinner
prescriptions at initial doctor visits, and didn’t see whether
people stopped or started medication based on follow-up exams, the
researchers also point out.
“It takes time and effort to have the appropriate discussion with
patients and their families and to prescribe and monitor these
therapies,” said Dr. Gregg Fonarow, co-director of the University of
California, Los Angeles Preventive Cardiology Program and researcher
at the David Geffen School of Medicine at UCLA.
Anticoagulants can reduce the risk of stroke for atrial fibrillation
patients by 80 percent, Fonarow, author of an accompanying
editorial, said by email.
“Patients with any history of atrial fibrillation who are not
receiving an oral anticoagulant should discuss with their physicians
the specific benefits and potential risks of treatment,” Fonarow
added.
SOURCE: http://bit.ly/1R3OPR9 and http://bit.ly/1ZwNjdw JAMA
Cardiology, online March 16, 2016.
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