Prevailing Practices of Usage of Oral Anticoagulant in Stroke Prevention in Atrial Fibrillation (SPAF) in Indian Patients: Results of a Multicenter, Cross Sectional Questionnaire Based Physician Survey

Objective: Understanding physician’s opinion on usage and challenges for use of oral anticoagulants (OACs) in SPAF (Stroke Prevention in Atrial Fibrillation).
Materials and Methods: A multicenter questionnaire based survey was conducted among Indian physicians. Questionnaire included items related to number of patients with atrial fibrillation (AF) seen, use of different scoring systems, international normalized ratio (INR) monitoring, issues preventing prescription of OAC, perceived concerns while using vitamin K antagonists (VKA) in SPAF.
Results: Ninety-three physicians participated. Mean number of AF patients seen by doctors per month was 28.05(60.02). Seventy-two (77.4%) and 47(50.5%) physicians reported using “CHA 2 DS 2-VASc” and the “HAS BLED score” respectively. Routine use of VKA and aspirin was reported by 71(76.3%) and 60(64.5%) physicians respectively. Thirty-one (33.3%) physician reported INR monitoring twice per week at the time of diagnosis until patient is stabilized within therapeutic range. During dosage adjustment, INR monitoring is performed twice a month by 38(40.9%) physicians. When the patient is stable on treatment, 47(50.5%) reported monitoring 3-6 times per year. Low diagnosis rate, difficulty of monitoring, low patient awareness and cost are the important limitations for use of OAC for SPAF. Inconvenience and burden of INR monitoring is an important/very important perceived issue by the patients for use of anti-coagulants in SPAF according to 89(95.7%) physicians. Seventy-six (81.7%) doctors reported that dose adjustment is very important/important challenge while using VKA in SPAF.
Conclusion: Burden of atrial fibrillation is high in India. Use of CHA 2 DS 2-VASc is common among Indian physicians. About two third physicians use VKA for SPAF. Poor diagnosis rate, difficulty of monitoring, low patient awareness and cost are the major limitations for using OAC for SPAF.