KUMJ | VOL. 24 | NO. 2 | ISSUE 95 | APRIL - JUNE, 2026

Antithrombotic Prescribing Pattern and Predictors of Oral Anticoagulants Use in Patients with Atrial Fibrillation: Results from a hospital-based cross-sectional study of Nepal
Koju Shrestha R, Bista D, Shakya R, Gurung RB, Koju RP

Abstract:
Background Patients with atrial fibrillation (AF) are at an increased risk of stroke and require oral anticoagulants (OACs) to reduce the risk of stroke and improve clinical outcomes. Guidelines do not recommend antiplatelet therapy without a specific indication; however, its use persists in clinical practice. Identifying the factors associated with oral anticoagulants use may help optimize patient care. Objective To assess the antithrombotic use pattern and predictors of oral anticoagulant use. Method This cross-sectional study included patients aged ≥ 18 years with atrial fibrillation who attended the cardiopulmonary unit of the Dhulikhel Hospital, Kathmandu University Hospital, from March 2022 to April 2023. Stroke risk was assessed using the CHA2DS2-VASc score. Patients taking antiplatelet agents, vitamin K antagonists, and non-vitamin K antagonists were considered to be receiving antithrombotic therapy. Binary logistic regression was performed to identify the predictors of oral anticoagulant use. Result Among 215 patients with atrial fibrillation, 63.2% were receiving oral anticoagulants, and 30.2% were on antiplatelet therapy. Within the oral anticoagulant group, rivaroxaban was the most commonly used (38.6%). Among patients classified as high risk of stroke, 61.8% were on oral anticoagulants, whereas 32.8% were on antiplatelet therapy. Congestive heart failure, coronary artery disease, and moderate-to-severe bleeding risk were identified as significant predictors of oral anticoagulant use among patients atrial fibrillation (p < 0.05). Conclusion Many patient atrial fibrillation were prescribed oral anticoagulants to prevent stroke; however, antiplatelet therapy continues to be administered. Congestive heart failure, coronary artery disease, and elevated bleeding risk predicted of oral anticoagulant use. These findings underscore the importance of optimizing oral anticoagulant therapy according to individual patient risk profiles.
Keyword : Atrial fibrillation, Oral anticoagulant, Predictor of oral anticoagulant