title: Utilization of antithrombotic therapy for stroke prevention in atrial fibrillation: a cross-sectional baseline analysis in general practice.
abstract: OBJECTIVE
  Antithrombotics for stroke prevention in atrial fibrillation (AF) are reportedly underutilised. Since the burden of care lies within general practice, attention must be paid to identifying and addressing practice gaps in this setting. The objective of this study was to determine the contemporary utilisation of antithrombotic therapy for stroke prevention in AF within Australian general practice (GP).
  
  
  METHODS
  Data pertaining to AF patients' (aged ≥65 years) were collected from GP surgeries in New South Wales, Australia, using purpose-designed data collection forms; extracted data comprised patients' medical histories, current pharmacotherapy, and relevant characteristics.
  
  
  CONCLUSIONS
  Data pertaining to 393 patients (mean age 78·0 ± 7·0 years) were reviewed. Overall, most (98·5%) patients received antithrombotic therapy. Among the 387 patients using antithrombotics, most (94·1%) received mono-therapy. "Warfarin ± antiplatelet" was most frequently used (81·7%); 77·5% used "warfarin" as a monotherapy, followed by "dabigatran ± clopidogrel" (11·6%), "aspirin" (5·9%) and "clopidogrel" alone (0·8%). High stroke risk and low bleeding risk were associated with increased use of "warfarin ± antiplatelet" therapy. Older patients (≥80 years) were more likely to receive 'nil therapy' (P = 0·04), and less likely to receive dual and triple antithrombotic therapy.
  
  
  CONCLUSIONS
  We found an encouraging improvement compared to previous studies in the utilisation of antithrombotic therapy for stroke prevention in AF within general practice. Warfarin is now utilised as the mainstay therapy, followed by aspirin, although the novel oral anticoagulants are entering the spectrum of therapies used. Consideration needs to be given to the potential impact of the newer agents and their scope of use.
authors.affiliation: Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Bajorek
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
authors.forename: P J
authors.initials: PJ
authors.lastname: Magin
authors.affiliation: Department of Clinical Pharmacology, Royal North Shore Hospital, St. Leonards, NSW, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Hilmer
authors.affiliation: Pharmacy, University of Sydney, Sydney, NSW, Australia.
authors.forename: I
authors.initials: I
authors.lastname: Krass
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D058006:General Practice; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D009517:New South Wales; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014859:Warfarin
keywords: anticoagulation; computerised decision support; drug utilization; elderly; general practitioner; medicine use; prescribing; preventive prescribing; warfarin