Prescribing patterns of anticoagulants in patients with atrial fibrillation in primary care

<p><strong>Introduction.</strong> Anticoagulants have the key role in prevention of thromboembolism including ischemic stroke, in patients with non-valvular atrial fibrillation (NVAF). The European Association of Cardiology (ESC) recommends new oral anticoagulant drugs (NOACs) as first choice therapy because of approved effectiveness and safety profile compared to vitamin K antagonists (VKAs). The aim of this study was to evaluate the frequency of prescribing anticoagulants in patients with NVAF, and the compatibility of the therapy with current recommendations for stroke prevention.<br /><strong>Methods.</strong> Our cross-sectional study, conducted from June 2023 to June 2024, included 238 patients with NVAF registered in the Primary Health Centre Banja Luka.  Patients’ medical records were used as the data source. The CHA2DS2-VASc and HAS-BLED instruments were used for the assessment of risk of stroke and bleeding.<br /><strong>Results. </strong>The majority of respondents were aged 65–84. Patients ≤ 65 years have a significantly lower risk of stroke (p=0.000). According to the CHA2DS2-VASc score, 219 patients were supposed to use anticoagulant therapy, however 73.5% of patients had adequate treatment. Mostly prescribed anticoagulants were VKAs (44.1%), followed by NOACs(29.4%), while 26.5% of patients did not use anticoagulants. The majority of patients with unregulated international normalized ratio (INR) were >75 years, and those with regulated INR were 65–74 years old (p=0.03). The risk of bleeding (HAS-BLED ≥ 3) was present in 40% of patients using anticoagulants.<br /><strong>Conclusion.</strong> Stroke prevention in patients with NVAF and prescribing NOACs are partially aligned with clinical recommendations. Insufficient NOACs usage has been noticed, despite their approved advantages. Additional activities are needed aiming anticoagulant therapy optimization, particularly in elderly and those with high risk for stroke.</p>