Abstract
Abstract
Atrial fibrillation (AF) is a major preventable cause of ischemic stroke and is increasingly encountered across hospital, ambulatory, and community pharmacy practice in Canada. Although oral anticoagulants substantially reduce thromboembolic risk, real-world pharmacotherapy remains complicated by inappropriate dose reduction, declining renal function, interacting medications, unnecessary concomitant antiplatelet therapy, poor adherence, transitions of care, and uncertainty surrounding interruption for procedures. Canadian practice offers a particularly important role for pharmacists because of their expanding prescribing authority and involvement across inpatient, primary care, anticoagulation clinic, and community settings. The Canadian Cardiovascular Society/Canadian Heart Rhythm Society approach emphasizes assessment of stroke risk using the CHADS-65 algorithm and generally favours direct oral anticoagulants (DOACs) over warfarin for eligible patients. Clinical pharmacists can improve anticoagulant safety by confirming indication, selecting the appropriate agent and dose, calculating renal function correctly, identifying drug interactions, eliminating unnecessary antithrombotic therapy, monitoring adherence and laboratory parameters, and ensuring appropriate transitions between hospital and community care. Canadian studies have further demonstrated that pharmacist-managed anticoagulation can achieve high-quality anticoagulant control and that pharmacist prescribing can address undertreatment of AF. This narrative review discusses practical pharmacotherapy challenges in AF anticoagulation and proposes a structured pharmacist-led approach applicable to contemporary Canadian practice
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Ethics & Declarations
Author Contributions
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by all authors. All authors read and approved the final manuscript.
Ethics Approval and Consent to Participate
Not applicable. This study did not involve human participants, animal experimentation, or confidential patient clinical data.
Consent for Publication
Not applicable, or informed consent for publication was obtained from all individual participants where relevant.
Competing Interests
The authors declare that they have no competing financial or non-financial interests.
Funding
The authors declare that no funds, grants, or other financial support were received during the preparation of this manuscript.
Data Availability Statement
Data sharing is not applicable to this article as no new datasets were generated or analyzed during the current study.
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© 2026 Mohamed Abdellatif et al. International Journal of Clinical Pharmacy and Medicine.