Oral anticoagulation in atrial fibrillation: A pan-European patient survey

Abstract 

Background

Anticoagulation with vitamin K antagonists (VKAs) provides effective stroke prophylaxis in patients with atrial fibrillation (AF). Optimisation of such therapy requires frequent monitoring, dose adjustments and stringent lifestyle restrictions. We conducted a large multinational survey in patients with chronic AF to gain insights into their perceptions and understanding of VKA use.

Methods

Eligible patients were adults with AF who had been prescribed VKAs for at least 1 year. A total of 711 patient interviews were conducted in seven European countries during June and July 2004.

Results

The majority of patients (58% male; mean age 68 years) claimed to understand their treatment programme; despite this, only 7% knew that VKA use is aimed at preventing strokes and 24% stated that they would have liked more information. Patients attended an average of 14 monitoring sessions in the previous year; however, 21% missed appointments, especially younger patients (<65 years). The International Normalized Ratio (INR) was within the target range in most or all of the last five to ten visits in 64% of patients; nonetheless, 38% were not aware that an INR outside the target range is associated with health risks. On average, patients required dose adjustments every four sessions. VKA treatment impacted 67% of patients in terms of diet, socialising, career and independence, especially younger patients (74%).

Conclusions

Monitoring, dose adjustments and lifestyle restrictions to optimise the intensity of anticoagulation with VKAs are problematic for patients with AF, and their knowledge of the consequences of such therapy is often poor.

Keywords: Anticoagulants, Atrial fibrillation, Stroke, Warfarin