Assessment of physicians practice regarding guidelines recommended antithrombotic therapy in patients with atrial fibrillation.

Abstract

Objective: To quantify adherence to guideline-recommended antithrombotic therapy among physicians managing AF and to identify prescribing trends. Study Design: Cross-Sectional study. Setting: Department of Cardiology, Indus Hospital, Karachi. Period: Three Months (13^th November, 2025 to 13^th February, 2026). Methods: Ninety physicians were enrolled via consecutive sampling. Adherence was defined per ESC 2024: OAC indicated for CHA₂DS₂-VA ≥2, considered at 1; antiplatelet therapy not recommended as an alternative to OAC; AF temporal pattern not used to decide anticoagulation. Demographics and prescribing were abstracted from records; associations with adherence were tested using chi-square with p≤0.05. Results: Overall, 72% of physicians adhered to guidelines. Adherence did not differ by patient age or gender; hypertension and family history of AF were associated with lower adherence, with anemia showing a non-significant association. DOACs (notably apixaban and rivaroxaban) were the most prescribed agents; DOAC use did not differ between adherent and non-adherent groups, while dual antiplatelet therapy (aspirin+clopidogrel) was more frequent among non-adherent physicians. Conclusion: In this study 72% physicians showed adherence to guideline-directed antithrombotic therapy, with specific patient factors (hypertension, family history, anemia) linked to under treatment. Reducing inappropriate reliance on dual antiplatelet therapy and reinforcing risk-based anticoagulation through focused education, standardized protocols, and structured bleeding-risk assessment may close the evidence-to-practice gap.