Use of antithrombotics in atrial fibrillation in Africa, Europe, Asia and South America: insights from the International RealiseAF Survey

Arch Cardiovasc Dis. 2014 Feb;107(2):77-87. doi: 10.1016/j.acvd.2014.01.001. Epub 2014 Feb 18.


Background: The implementation of international guidelines for antithrombotic use in atrial fibrillation (AF) in routine practice is not well known, particularly, in some parts of the world, such as the Middle East and Africa.

Aim: To describe and analyse the use of antithrombotics in patients with AF in routine practice.

Methods: The RealiseAF international cross-sectional survey enrolled 10,523 patients (with at least one documented AF episode in the preceding 12 months) from 831 sites. Participating physicians were randomly selected from physician list forms.

Results: Mean age was 66.6 ± 12.2 years. In 47.4% of the patients with a CHADS2 score ≥ 2, oral anticoagulants were not prescribed. Patients who had a CHADS2 score ≥ 2, permanent or persistent AF, valvular heart disease, a stroke leading to hospitalization in the previous year or treatment by a cardiologist (rather than an internist) were most likely to receive oral anticoagulants. Patients aged ≥ 75 years and those with coronary heart disease; major bleeding leading to hospitalization in the previous year or a rhythm control strategy was least likely to receive oral anticoagulants. Appropriate antithrombotic treatment was prescribed in 66.7% of the patients with a CHADS2 score ≥ 2 in the Middle East/Africa, 55.3% in Europe, 43.9% in Latin America and 31.7% in Asia.

Conclusion: There is substantial deviation from international guidelines in antithrombotic use for AF in routine clinical practice, with overuse and underuse of antithrombotics in about 50% of the cases and important geographical differences. These findings emphasize the need for improved medical education worldwide and a better understanding of geographical disparities in the implementation of guidelines.

Keywords: AVC; Anticoagulants oraux; Atrial fibrillation; Contrôle du rythme; Fibrillation atriale; Oral anticoagulants; Rhythm control; Stroke.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adult
  • Africa / epidemiology
  • Aged
  • Aged, 80 and over
  • Anticoagulants / administration & dosage
  • Anticoagulants / therapeutic use*
  • Asia / epidemiology
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / drug therapy*
  • Atrial Fibrillation / epidemiology
  • Cross-Sectional Studies
  • Drug Utilization Review
  • Europe / epidemiology
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Fibrinolytic Agents / therapeutic use*
  • Guideline Adherence
  • Health Care Surveys
  • Humans
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'
  • South America / epidemiology


  • Anticoagulants
  • Fibrinolytic Agents