Oral Anticoagulation

Oral anticoagulation prevents ischemic stroke in patients with atrial fibrillation and is guideline-recommended for AF patients at thromboembolic risk. Long-term effective OAC therapy can reduce stroke risk by 64%. The base case assumed complete OAC uptake after atrial fibrillation detection, while scenarios tested lower uptake rates of 90% and 76%. OAC uptake in practice may be lower than the base-case assumption because of refusal, contraindications, bleeding complications, and follow-up deviations. Prior Australian evidence found that one in four high-risk patients received no or inadequate OAC therapy. Evidence from related trials suggests probable benefit of DOACs for device-detected subclinical atrial fibrillation after stroke, but definitive evidence in the LAD/SVD subgroup is lacking. In the model, patients switched from aspirin to a direct oral anticoagulant after atrial fibrillation was detected unless prior bleeding precluded it. GPs reported barriers to starting anticoagulation including lack of confidence, training, knowledge, and deferral to cardiologists. Patients who had hemorrhagic stroke while taking OAC were permanently switched to aspirin in the model. Anticoag…