Snapshot of anticoagulation practice in an inner London Borough in patients with known diagnosis of atrial fibrillation: Time for change
Abstract 
Background:
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. It is a strong risk factor for embolic stroke, such that anticoagulation is recommended for the majority of patients. However, many patients for whom anticoagulation is indicated do not receive appropriate therapy.
Aims:
To assess anticoagulation usage in patients with known AF prior to hospital admission.  
Methods:
A standardized proforma was designed to collect data from inpatient notes and electronic letters for inpatients over four months in a district general hospital.
Results:
One hundred seven patients were included, of whom 36% were not anticoagulated.  Of these, only 37% had a documented reason for withholding therapy despite a mean CHA2DS2-VASc of 5. Common reasons included bleeding risk and risk of falls. Warfarin was the agent of choice in 48% of patients and Direct Oral Anticoagulants (DOACs) in 52%. Concerningly, 76% of patients on warfarin were admitted with an INR not in range; 56% of which were subtherapeutic. Of those on DOACs, only 75% were on the appropriate dose. Notably 37% of patients not anticoagulated prior to admission were initiated on therapy on discharge. 
Conclusion:
Many patients in whom anticoagulation is indicated are receiving inappropriate dosage, or are not receiving treatment at all, thus increasing their risk of embolic stroke. Many are identified and anticoagulated during acute admissions, indicating inadequate anticoagulation in the community. There is pressing need for changes in anticoagulation practices in community urgently

SNAPSHOT OF ANTICOAGULATION PRACTICE IN AN INNER LONDON BOROUGH IN PATIENTS WITH KNOWN DIAGNOSIS OF ATRIAL FIBRILLATION: TIME FOR CHANGE