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A cluster-randomized controlled trial of a computerized antithrombotic risk assessment tool to optimize stroke prevention in general practice: a study protocol
This study (a prospective, cluster-randomized controlled clinical trial) will be conducted across selected regions in the state of New South Wales, Australia. Fifty GPs will be randomized to either the 'intervention' or 'control' arm, with each GP recruiting 10 patients (aged>=65 with AF); target sample size is 500 patients. GPs in the intervention arm will use CARAT during routine patient consultations to: assess risk factors for stroke, bleeding and medication misadventure; quantify the risk/benefit ratio of antithrombotic treatment, identify the recommended therapy, and decide on the treatment course, for an individual ...
Source: BMC Health Services Research - February 7, 2014 Category: Journals (General) Authors: Beata BajorekParker MaginSarah HilmerInes Krass Source Type: research

Utilization of antithrombotic therapy for stroke prevention in atrial fibrillation: a cross‐sectional baseline analysis in general practice
Conclusion: 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. There has been an encouraging temporal improvement in the utilization of antithrombotic therapy for stroke prevention in AF within general practice. Anticoagulants (mostly warfarin) are now utilized ...
Source: Journal of Clinical Pharmacy and Therapeutics - June 23, 2016 Category: Drugs & Pharmacology Authors: B. Bajorek, P. J. Magin, S. Hilmer, I. Krass Tags: Original Article Source Type: research

Utilization of antithrombotic therapy for stroke prevention in atrial fibrillation: a cross ‐sectional baseline analysis in general practice
Conclusion: 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. There has been an encouraging temporal improvement in the utilization of antithrombotic therapy for stroke prevention in AF within general practice. Anticoagulants (mostly warfarin) are now utilized ...
Source: Journal of Clinical Pharmacy and Therapeutics - June 23, 2016 Category: Drugs & Pharmacology Authors: B. Bajorek, P. J. Magin, S. Hilmer, I. Krass Tags: Original Article Source Type: research

Early real-world evidence of persistence on oral anticoagulants for stroke prevention in non-valvular atrial fibrillation: a cohort study in UK primary care
Conclusions Observed differential prescribing of OACs can result in channelling bias in comparative effectiveness research. Persistence patterns changed over follow-up time, but there are indications of improved persistence rates with apixaban over other OACs in the UK. A larger study with longer follow-up is needed to corroborate findings. This study is registered on ClinicalTrials.gov (NCT02488421).
Source: BMJ Open - September 25, 2016 Category: Journals (General) Authors: Johnson, M. E., Lefevre, C., Collings, S.-L., Evans, D., Kloss, S., Ridha, E., Maguire, A. Tags: Open access, Cardiovascular medicine, Epidemiology, General practice / Family practice Research Source Type: research

Atrial fibrillation and oral anticoagulation in older people with frailty: a nationwide primary care electronic health records cohort study
ConclusionAmong older people in England, AF and stroke risk increased with increasing degree of frailty; however, OAC prescription approximated 50%. Given competing demands of mortality, morbidity and stroke prevention, greater attention to stratified stroke prevention is needed for this group of the population.
Source: Age and Ageing - December 16, 2020 Category: Geriatrics Source Type: research

Two-year outcomes of UK patients newly diagnosed with atrial fibrillation: findings from the prospective observational cohort study GARFIELD-AF
CONCLUSION: The data support a benefit of anticoagulation in reducing stroke and death, without an increased risk of a major bleed in patients with new-onset AF. Anticoagulation treatment in patients at high risk of stroke who are not receiving anticoagulation may further improve outcomes.PMID:35577587 | DOI:10.3399/BJGP.2021.0548
Source: The British Journal of General Practice - May 16, 2022 Category: Primary Care Authors: Patricia N Apenteng Saverio Virdone Fd Richard Hobbs A John Camm Keith Aa Fox Karen S Pieper Gloria Kayani David Fitzmaurice GARFIELD UK investigators* Source Type: research

Using primary care data to assess comparative effectiveness and safety of apixaban and rivaroxaban in patients with nonvalvular atrial fibrillation in the UK: an observational cohort study
Conclusions Among patients with nonvalvular AFib, apixaban was as effective as rivaroxaban in reducing rate of stroke and safer in terms of major bleeding episodes. This head-to-head comparison supports conclusions drawn from indirect comparisons of DOAC trials against warfarin and demonstrates the potential for real-world evidence to fill evidence gaps and reduce uncertainty in both health technology assessment decision-making and clinical guideline development.
Source: BMJ Open - October 17, 2022 Category: General Medicine Authors: Jaksa, A., Gibbs, L., Kent, S., Rowark, S., Duffield, S., Sharma, M., Kincaid, L., Ali, A. K., Patrick, A. R., Govil, P., Jonsson, P., Gatto, N. Tags: Open access, Cardiovascular medicine Source Type: research

Addressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: Proceedings, Washington, DC, December 3-4, 2012
Approximately half of patients with atrial fibrillation and with risk factors for stroke are not treated with oral anticoagulation (OAC), whether it be with vitamin K antagonists (VKAs) or novel OACs (NOACs); and of those treated, many discontinue treatment. Leaders from academia, government, industry, and professional societies convened in Washington, DC, on December 3-4, 2012, to identify barriers to optimal OAC use and adherence and to generate potential solutions. Participants identified a broad range of barriers, including knowledge gaps about stroke risk and the relative risks and benefits of anticoagulant therapies;...
Source: American Heart Journal - April 25, 2014 Category: Cardiology Authors: Paul L. Hess, Michael J. Mirro, Hans-Christoph Diener, John W. Eikelboom, Sana M. Al-Khatib, Elaine M. Hylek, Hayden B. Bosworth, Bernard J. Gersh, Daniel E. Singer, Greg Flaker, Jessica L. Mega, Eric D. Peterson, John S. Rumsfeld, Benjamin A. Steinberg, Tags: Results of Expert Meetings Source Type: research

Incidence of nonvalvular atrial fibrillation and oral anticoagulant prescribing in England, 2009 to 2019: A cohort study
ConclusionsThe incidence of NVAF increased between 2009 and 2015, before plateauing. Underprescribing of OACs in NVAF is associated with a range of comorbidities, ethnicity, and socioeconomic factors, demonstrating the need for initiatives to reduce inequalities in the care for AF patients.
Source: PLoS Medicine - June 7, 2022 Category: Internal Medicine Authors: Alyaa M. Ajabnoor Source Type: research

Cardiovascular, Bleeding, and Mortality Risks in Elderly Medicare Patients Treated with Dabigatran or Warfarin for Non-Valvular Atrial Fibrillation.
CONCLUSIONS: -In general practice settings, dabigatran was associated with reduced risk of ischemic stroke, intracranial hemorrhage, and death, and increased risk of major gastrointestinal hemorrhage compared with warfarin in elderly patients with non-valvular AF. These associations were most pronounced in patients treated with dabigatran 150 mg twice daily, whereas the association of 75 mg twice daily with study outcomes was indistinguishable from warfarin except for a lower risk of intracranial hemorrhage with dabigatran. PMID: 25359164 [PubMed - as supplied by publisher]
Source: Circulation - October 30, 2014 Category: Cardiology Authors: Graham DJ, Reichman ME, Wernecke M, Zhang R, Southworth MR, Levenson M, Sheu TC, Mott K, Goulding MR, Houstoun M, MaCurdy TE, Worrall C, Kelman JA Tags: Circulation Source Type: research

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