Appropriateness of oral anticoagulant therapy and associated factors among hospitalized atrial fibrillation patients with the CHA2DS2-VASc score of 1 (beyond sex)

Atrial fibrillation (AF) is the most common cardiac rhythm disturbances associated with increased risks of mortality. Oral anticoagulant (OAC) reduces AF-related strokes. However, the pattern of OAC use among AF patients is unknown in Ethiopia. This study evaluated the appropriateness of OAC therapy and associated factors among hospitalized AF patients. A retrospective cross-sectional study was conducted among AF patients hospitalized in medical ward of Adigrat general hospital. Previously validated CHA 2 DS 2 -VASc and HAS-BLED scores were used to predict risk of stroke and bleeding, respectively. Multivariate logistic regression was used to identify factors associated with OAC therapy. Data was analyzed using Statistical Package for Social Sciences, setting p -value < 0.05 as a statistically significant. Of the total 84 AF patients, more than half (52.4%) were females and their median age was 64.50 (75–39.5). About 42.9 and 31.0% of the patients were at high risks of stroke and bleeding, respectively. Thirty seven (44.0%) of the patients received no antithrombotics and almost half (48.8%) of them were not prescribed OAC. On the other hand, 51.2% of patients received OAC containing regimen, 40.5% were prescribed with OAC monotherapy and 4.8% received aspirin monotherapy. Among patients at high risk of stroke, 36.1% of them received no antithrombotic drug. Regarding risk of bleeding, the prescription of OAC containing regimen among patients at high risk of bleeding was lower than in those at low risk of bleeding (41.9% versus 56.6%). Almost two third (61.9%) of AF patients were prescribed inappropriately, dominantly being underprescribed (44.0%). Admission time for AF was significantly associated ( p < 0.001) with prescription of OAC (Adjusted Odds ratio = 6.587, CI: 2.273 − 19.091 ) . Substantial proportions of AF patients at high risk of stroke were inappropriately prescribed with OACs. Inappropriate prescription was characterized by underprescription. The cardiologists of the hospital should follow AF guidelines to improve prescription patterns with an ultimate goal of improving treatment outcomes.