Unmet need and limitations of current anticoagulation therapy for stroke prevention in atrial fibrillation patients: a questionnaire based study

Maulin Dhiren Mehta


Background: Atrial fibrillation (AF) is one of the commonest of cardiac arrhythmia. Non-valvular atrial fibrillation (NVAF) leads to increase in risks of stroke and death. The ‘stroke prevention in atrial fibrillation’ (SPAF) trial have shown that oral anticoagulation therapy (warfarin) is the most effective drug for SPAF. On the other side, warfarin is associated with the risk of serious bleeding. Complications associated with warfarin lead us to in urge of search for effective, safer and convenient newer oral anticoagulation therapy (NOAC).

Methods: The study was observational, non-interventional and prospective questionnaire based, willingly participated by 20 cardiologists of Vadodara. It was done to assess the prevalence of NVAF, to find out unmet need and limitations of warfarin and future of newer oral anticoagulation drugs.

Results: According to cardiologists, prevalence of NVAF was 2.5-3% in vadodara, India. Prophylactic therapy for SPAF was given after evaluating CHA2DS2-VASc score and choice of therapy was warfarin for 60% of total cardiologists. Total 90% of the cardiologists mentioned that bleeding and continuous monitoring are the commonly encountered problems due to warfarin. According to all cardiologists, warfarin is unsafe due to its serious side effects and change is required. NOAC therapy without antidote can be accepted by all, if they are safe enough. Total 90% of cardiologists mentioned that NOAC drugs must have better safety with comparable efficacy to warfarin.

Conclusions: Safety issues and continuous INR monitoring are the limitations of warfarin. Cheaper NOAC therapy with better safety and comparable efficacy to warfarin is the major requirement.


NVAF, SPAF, Warfarin, NOAC

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