As many as 25% of patients with atrial fibrillation (AF) at the lowest risk for stroke may be taking oral anticoagulants despite current guidelines, according to a research letter published online in JAMA Internal Medicine.

Jonathan C. Hsu, MD, MAS, of the University of California, San Diego, and colleagues reviewed data in the Practice Innovation and Clinical Excellence (PINNACLE) Registry of the National Cardiovascular Data Registry from 2008–2012 to evaluate the prevalence of non-guideline adhering oral anticoagulant prescribing in young and healthy patients at the lowest risk for thromboembolism. Records of nearly 11,000 patients aged ≤60 years were included in the PINNACLE registry.

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Approximately 25% of patients with AF at a low risk of stroke were prescribed oral anticoagulant therapy against current guideline recommendations; males with AF at the lowest risk of stroke were more likely to be prescribed oral anticoagulants vs. females, as well as older patients and overweight patients without stroke risk factors.

Dr. Hsu notes that in patients with no risk factors for stroke, the risk of bleeding may outweigh the potential benefits of stroke reduction with oral anticoagulant therapy. Clinicians need to be aware of the potential risks associated with these medications in patients with a low risk of stroke in AF treatment plans.

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