title: A prospective study investigating the causes of warfarin under-utilization in Chinese patients.
abstract: Background Warfarin is efficacious for ischemic stroke prevention in intermediate- to high-risk patients with atrial fibrillation; thus, warfarin is the recommended treatment according to evidence-based guidelines. Objective This prospective study evaluated the reasons for under-utilization of warfarin in Chinese patients with non-valvular atrial fibrillation (NVAF). Setting The People's Hospital of Henan Province of Zhengzhou City, which is a 3900-bed tertiary-care teaching institution. Methods We extracted data from an existing patient database. Patients at risk for thromboembolism were categorized based on CHA2DS2-VASc [congestive heart failure, hypertension, age ≥75 (doubled), diabetes, prior stroke (doubled), vascular disease, age 65-74 years, and sex category (female)] scores. Main outcome measure The percent of warfarin utilization was estimated in recruited patients. Any demographic and clinical factors associated with warfarin under-utilization were identified using a logistic regression model. Results Among the patient sample (n = 612), 569 patients had a CHA2DS2-VASc score of ≥1. At presentation, warfarin under-utilization was estimated to be 27.1 %. Only 120 patients (25.1 %) considered to be at the highest risk were prescribed warfarin. Binary logistic regression analysis indicated that previous stroke, age ≥75 years, and anti-platelet therapy were associated with warfarin under-utilization. Conclusion Patients with CHA2DS2-VASc scores ≥1 who were admitted with NVAF were under prescribed warfarin, and 138 patients were not treated with either warfarin or other antithrombotic therapies. In conclusion, a more aggressive approach for stroke prevention in NVAF patients is required.
authors.affiliation: Department of Pharmacy, People's Hospital of Henan Province, Zhengzhou, 450003, Henan, China.
authors.forename: Shujuan
authors.initials: S
authors.lastname: Zhao
authors.affiliation: Department of Pharmacy, People's Hospital of Henan Province, Zhengzhou, 450003, Henan, China.
authors.forename: Hongwei
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Department of Cardiovascular Medicine, People's Hospital of Henan Province, Zhengzhou, 450003, Henan, China.
authors.forename: Xianpei
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular Medicine, People's Hospital of Henan Province, Zhengzhou, 450003, Henan, China.
authors.forename: Chuanyu
authors.initials: C
authors.lastname: Gao
authors.affiliation: Department of Pharmacy, People's Hospital of Henan Province, Zhengzhou, 450003, Henan, China. qinyuhua3999@163.com.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Qin
authors.affiliation: Department of Pharmacy, People's Hospital of Henan Province, Zhengzhou, 450003, Henan, China.
authors.forename: Haixia
authors.initials: H
authors.lastname: Cai
authors.affiliation: Department of Pharmacy, People's Hospital of Henan Province, Zhengzhou, 450003, Henan, China.
authors.forename: Boya
authors.initials: B
authors.lastname: Chen
authors.affiliation: Department of Pharmacy, People's Hospital of Henan Province, Zhengzhou, 450003, Henan, China.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Cao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D002681:China / Q000453:epidemiology; D004363:Drug Utilization / Q000592:standards* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control; D013923:Thromboembolism / Q000188:drug therapy* / Q000453:epidemiology; D014859:Warfarin / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Atrial fibrillation; Atrial flutter; China; Prevention; Stroke; Warfarin