June 17, 2015
Quarter of Cardiologist-Prescribed
Anticoagulants Inappropriate

San Francisco—About a quarter of oral anticoagulants prescribed by cardiology specialists are not only medically unnecessary, based on current and past guideline recommendations, they also are potentially harmful, according to a new study.

Oral anticoagulation is not recommended in patients younger than age 60 without heart disease or other known risk factors for thromboembolism or in atrial fibrillation (AF) patients without any established risk factor for stroke, according to background information in the research letter published recently in JAMA Internal Medicine.

In fact, previous guidelines, in use when data for this study were collected, took an even stronger position in recommending that anticoagulants be avoided in those groups, according to the study team, led by University of California San Francisco researchers.

“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. “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.”

While anticoagulation with warfarin or newer therapies reduces morbidity and mortality for AF patients at risk for thromboembolism, it is not recommended for AF patients at a particularly low risk for stroke because of potential bleeding complications.

For the study, researchers examined records from 2008 to 2012 for nearly 11,000 patients nationwide, age 60 and under, from the overall Practice Innovation and Clinical Excellence (PINNACLE) Registry of the National Cardiovascular Data Registry.

Despite guideline recommendations, 25% of patients, 2,561, were prescribed oral anticoagulant therapy, especially if they were males with AF, older, or overweight without stroke risk factors, the review found.

“Practitioners who prescribe blood thinners need to be diligent about weighing the risks and benefits of these medications,” said lead author Jonathan C. Hsu, MD, MAS. “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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