Abstract
Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia and can lead to significant comorbidities and
mortality. Persistence with oral anticoagulation (OAC) is crucial to prevent stroke but rates of discontinuation are high. This
systematic review explored underlying reasons for OAC discontinuation.
Methods: A systematic review was undertaken to identify studies that reported factors influencing discontinuation of OAC
in AF, in 11 databases, grey literature and backwards citations from eligible studies published between 2000 and 2019. Two
reviewers independently screened titles, abstracts and papers against inclusion criteria and extracted data. Study quality was
appraised using Gough’s weight of evidence framework. Data were synthesised narratively.
Results: Of 6,619 sources identified, 10 full studies and 2 abstracts met the inclusion criteria. Overall, these provided moderate
appropriateness to answer the review question. Four reported clinical registry data, six were retrospective reviews of patients’
medical records and two studies reported interviews and surveys. Nine studies evaluated outcomes relating to dabigatran
and/or warfarin and three included rivaroxaban (n = 3), apixaban (n = 3) and edoxaban (n = 1). Bleeding complications and
gastrointestinal events were the most common factors associated with discontinuation, followed by frailty and risk of falling.
Patients’ perspectives were seldom specifically assessed. Influence of family carers in decisions regarding OAC discontinuation
was not examined.
Conclusion: The available evidence is derived from heterogeneous studies with few relevant data for the newer direct oral
anticoagulants. Reasons underpinning decision-making to discontinue OAC from the perspective of patients, family carers
and clinicians is poorly understood.
mortality. Persistence with oral anticoagulation (OAC) is crucial to prevent stroke but rates of discontinuation are high. This
systematic review explored underlying reasons for OAC discontinuation.
Methods: A systematic review was undertaken to identify studies that reported factors influencing discontinuation of OAC
in AF, in 11 databases, grey literature and backwards citations from eligible studies published between 2000 and 2019. Two
reviewers independently screened titles, abstracts and papers against inclusion criteria and extracted data. Study quality was
appraised using Gough’s weight of evidence framework. Data were synthesised narratively.
Results: Of 6,619 sources identified, 10 full studies and 2 abstracts met the inclusion criteria. Overall, these provided moderate
appropriateness to answer the review question. Four reported clinical registry data, six were retrospective reviews of patients’
medical records and two studies reported interviews and surveys. Nine studies evaluated outcomes relating to dabigatran
and/or warfarin and three included rivaroxaban (n = 3), apixaban (n = 3) and edoxaban (n = 1). Bleeding complications and
gastrointestinal events were the most common factors associated with discontinuation, followed by frailty and risk of falling.
Patients’ perspectives were seldom specifically assessed. Influence of family carers in decisions regarding OAC discontinuation
was not examined.
Conclusion: The available evidence is derived from heterogeneous studies with few relevant data for the newer direct oral
anticoagulants. Reasons underpinning decision-making to discontinue OAC from the perspective of patients, family carers
and clinicians is poorly understood.
| Original language | English |
|---|---|
| Pages (from-to) | 1108-1117 |
| Number of pages | 10 |
| Journal | Age and Ageing |
| Volume | 50 |
| Issue number | 4 |
| Early online date | 10 Mar 2021 |
| DOIs | |
| Publication status | Published - 28 Jun 2021 |
Keywords
- Atrial Fibrillation
- Oral anticoagulation
- Discontinuation
- adherence
- older people
