Priority areas - Anticoagulants in atrial fibrillation

Data from the 2018-2019 Sentinel Stroke Audit highlights that 61% of patients across Wales, England and Northern Ireland with known atrial fibrillation prior to a stroke, were on anticoagulant medication. Although this figure has increased in recent years, there is still a large proportion of patients with known AF that are at greater risk of stroke as they are not anticoagulated, therefore highlighting the need to identify and review these patients.

Patients with AF who have refused anticoagulation should review this decision in conjunction with their prescriber at least annually.

Anticoagulation

  • Atrial fibrillation causes around 20% of strokes, however this can be reduced by about two thirds if people are anticoagulated.
  • NICE guidelines recommend that patients with atrial fibrillation are assessed for stroke risk using the CHA2DS2VASc score.
  • Adults with non-valvular atrial fibrillation and a CHA2DS2VASc score of 2 or above are at a much higher risk of having a stroke than the general population, and should therefore receive anticoagulation.
  • NICE recommends anticoagulation with either apixaban, dabigatran etexilate, edoxaban, rivaroxaban or a Vitamin K antagonist.

Percentage of patients with AF and a CHA2DS2-VASc score of 2 or more who are currently treated with anticoagulant therapy – quarter ending March 2019

Percentage of patients wiht AF who are anticoagulated v2

Please note, this data is currently only available up to March 2019 and is therefore in the former health board structures

 How can changes be made ?

  • Patients with persistent or permanent AF should be assessed for stroke risk using the CHA2DS2VASc score.
  • For patients with a CHA2DS2VASc of 2 or above, anticoagulation should be offered, taking the patient’s bleeding risk into account.

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