The utilization of antithrombotic prophylaxis for atrial fibrillation in a geriatric rehabilitation hospital

OBJECTIVE: To determine the utilization of anticoagulant and antithrombotic agents in older patients with atrial fibrillation. DESIGN: Retrospective chart review. SETTING: A geriatric rehabilitation hospital. PATIENTS: Subjects were 102 patients with atrial fibrillation as an intermittent or prevailing cardiac rhythm during a hospital admission in the 1993 fiscal year. MEASUREMENTS: Age, sex, and mental status of the patients; duration and etiology of atrial fibrillation; presence of contraindications to anticoagulants or antithrombotic agents; and utilization of these agents in this population. RESULTS: Of 102 older patients with atrial fibrillation at admission, only 51 were taking some form of anticoagulant or antithrombotic therapy proven effective for stroke prophylaxis (19 warfarin and 32 aspirin). Although 67 patients had relative contraindications to anticoagulation with warfarin, only 25 of the 35 with no contraindications were taking warfarin at the time of discharge. In addition, of the 43 patients with contraindications to warfarin but no contraindications to aspirin, only 28 were prescribed antithrombotic therapy. CONCLUSIONS: Although anticoagulation or antithrombotic therapies for atrial fibrillation appear to be relatively widely used, there are still significant windows of opportunity for the improvement of clinician practice patterns and clinical outcomes in older patients.