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Of the 651 patients in AF,273(42%)received no emboli prophylaxis while 219 (34%)were treated with AC(warfarin),146(22%)were treated with AP,and 13 (2%)received both agents.Patients discharged in AF from community hospitals were significantly less likely to be treated with either AC or AP agents than patients discharged from tertiary centers.A strong bias against thromboembolism prophylaxis with either AC or AP agents in AF existed with age over 45 years.Multivariate logistic regression indicated that the decision to treat was associated only with the presents of prosthetic valve,history of prior stroke,mitral disease,and absence of a recent gastrointestinal bleed or occult blood in stool.Even after adjustment for these factors,a significant bias against treatment of either AC or AP agents with advancing age and discharge from community hospitals remains.Thromboembolism prophylaxis with either AC or AP agents is underutilized in the setting of AF.Furthermore,factors known to increase the risk of embolization of AF such as age,hypertension,diabetes, and heart disease were not associated with decisions to treat with with AP or AC agents.This study suggests that the use of clinical guidelines suggested by trial of thromboembolism prophylaxis in AF could reduce the incidence of stroke. |
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