Addressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: Proceedings, Washington, DC, December 3-4, 2012.

Hess, Paul L

Mirro, Michael J

Diener, Hans-Christoph

Eikelboom, John W

Al-Khatib, Sana M

Hylek, Elaine M

Bosworth, Hayden B

Gersh, Bernard J

Singer, Daniel E

Flaker, Greg

Mega, Jessica L

Peterson, Eric D

Rumsfeld, John S

Steinberg, Benjamin A

Kakkar, Ajay K

Califf, Robert M

Granger, Christopher B

Atrial Fibrillation Think-Tank Participants

2024-02-01T15:45:59Z

2024-02-01T15:45:59Z

2014-09

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; lack of awareness regarding the potential use of NOAC agents for VKA-unsuitable patients; lack of recognition of expanded eligibility for OAC; lack of availability of reversal agents and the difficulty of anticoagulant effect monitoring for the NOACs; concerns with the bleeding risk of anticoagulant therapy, especially with the NOACs and particularly in the setting of dual antiplatelet therapy; suboptimal time in therapeutic range for VKA; and costs and insurance coverage. Proposed solutions were to define reasons for oral anticoagulant underuse classified in ways that can guide intervention and improve use, to increase awareness of stroke risk as well as the benefits and risks of OAC use via educational initiatives and feedback mechanisms, to better define the role of VKA in the current therapeutic era including eligibility and ineligibility for different anticoagulant therapies, to identify NOAC reversal agents and monitoring strategies and make knowledge regarding their use publicly available, to minimize the duration of dual antiplatelet therapy and concomitant OAC where possible, to improve time in therapeutic range for VKA, to leverage observational data sets to refine understanding of OAC use and outcomes in general practice, and to better align health system incentives.

S0002-8703(14)00216-6

0002-8703

1097-6744

https://hdl.handle.net/10161/30025

eng

Elsevier BV

American heart journal

10.1016/j.ahj.2014.04.007

https://creativecommons.org/licenses/by-nc/4.0

Atrial Fibrillation Think-Tank Participants

Humans

Atrial Fibrillation

Vitamin K

Anticoagulants

Drug Therapy, Combination

Administration, Oral

Risk Assessment

Patient Compliance

Insurance Coverage

District of Columbia

Stroke

Addressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: Proceedings, Washington, DC, December 3-4, 2012.

Journal article

Al-Khatib, Sana M|0000-0002-3561-0146

Bosworth, Hayden B|0000-0001-6188-9825

Peterson, Eric D|0000-0002-5415-4721

Granger, Christopher B|0000-0002-0045-3291

239

247.e1

3

Duke

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School of Nursing

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Staff

Nursing

Basic Science Departments

Clinical Science Departments

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Medicine

Psychiatry & Behavioral Sciences

Medicine, Cardiology

Medicine, General Internal Medicine

Duke Cancer Institute

Duke Clinical Research Institute

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Center for the Study of Aging and Human Development

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Duke Science & Society

Population Health Sciences

Duke Innovation & Entrepreneurship

Psychiatry & Behavioral Sciences, Behavioral Medicine & Neurosciences

Duke - Margolis Center For Health Policy

Published

168