Knowledge, Attitude, Practice, and Clinical Outcomes Regarding Oral Anticoagulants among Patients with Atrial Fibrillation: A Scoping Review

Abstract Background: Atrial fibrillation (AF), the most common sustained arrhythmia, has an estimated prevalence of 2% to 4% in the global population and increases stroke risk fivefold. Oral anticoagulants (OACs), which include vitamin K antagonists (VKAs) and direct OACs (DOACs), are critical for thromboembolic prevention. Nevertheless, patient knowledge, attitudes, and practices (KAP) deficits perpetuate a lack of compliance. Underutilization and unsatisfactory outcomes disproportionately affect socioeconomically disadvantaged groups. Aim: To map the existing literature evaluating KAP and associated clinical outcomes among adults with AF receiving OACs. Methods: Guided by Arksey and O'Malley's framework and Preferred reporting items for systematic review and meta-analysis extension for scoping reviews (PRISMA-ScR), this scoping review included results of a comprehensive search of PubMed/MEDLINE, Scopus, ScienceDirect, and CINAHL (1 January 2020–20 October 2025) for the above English-language studies with quantitative, qualitative, and mixed-methods designs. Search strategy was based on the PCC framework (population, concept, context) with keywords. Finally, 13 relevant studies underwent narrative synthesis and inductive thematic analysis to identify patterns, predictors, and intervention effects, following the Joanna Briggs Institute (JBI) approach. Results: The predominant knowledge gaps (62-66% inadequate comprehension of adverse effects, monitoring, and interactions) were more prevalent in DOAC than VKA users, with knowledge affecting attitudes and adherence. While deficient KAP was associated with an increased risk of stroke, adequate knowledge was associated with a significant reduction in risk (adjusted hazard ratios 0.03–0.46 for knowledge-attenuated events). Sociodemographic imbalances (low education, advanced age, deprivation) exacerbated disparities; tailored treatments (e.g., pharmacist-led counselling, digital platforms) minimized gaps by 34-66%, increasing satisfaction and self-management. Conclusions: KAP deficits are modifiable predictors of AF morbidity, highlighting systemic disparities in OACs therapy. Equity-oriented, multipronged methods that combine organized education, digital innovations, and provider training show potential for increasing adherence and reducing problems. Prospective, multicenter trials are necessary to clarify causal processes, scale interventions, and incorporate novel medicines (e.g., factor XI inhibitors), thus easing the escalating worldwide burden.