This article is more than 5 years old. Information may no longer be current.
Anticoagulation often inadequate in patients with AF, ischemic stroke
Click Here to Manage Email Alerts
Inadequate anticoagulation occurred often in patients with atrial fibrillation who had an acute ischemic stroke, according to a retrospective observational study published in JAMA.
The researchers analyzed 94,474 patients with history of AF and known ischemic stroke admitted from October 2012 to March 2015 to one of 1,622 hospitals in the Get With the Guidelines–Stroke program.
The purpose was to determine the prevalence of guideline-recommended antithrombotic treatment in this population, as well as to examine the link between preceding antithrombotic therapy, stroke severity and in-hospital outcomes.
The primary outcomes were stroke severity as measured by NIH Stroke Scale score and mortality.
Among the cohort, before stroke, 7.6% were assigned warfarin (INR 2), 8.8% were assigned nonvitamin K antagonist oral anticoagulants and 83.6% were not assigned therapeutic anticoagulation, Ying Xian, MD, PhD, from the department of neurology at Duke Clinical Research Institute, and colleagues wrote.
Of those not assigned therapeutic anticoagulation, 13.5% were assigned warfarin at an inadequate INR (< 2), 39.9% were assigned antiplatelets alone and 30.3% received no antithrombotic treatment, according to the researchers.
The researchers characterized 91,155 patients as high risk (CHA2DS2-VASc score 2). Of those, 83.5% did not receive therapeutic warfarin or nonvitamin K antagonist oral anticoagulants before their stroke.
Unadjusted rates for moderate or severe stroke (NIH Stroke Scale score 16) were lower in those assigned therapeutic warfarin (15.8%; 95% CI, 14.8-16.7) or nonvitamin K antagonist oral anticoagulants (17.5%; 95% CI, 16.6-18.4) than in those assigned no antithrombotic therapy (27.1%; 95% CI, 26.6-27.7), antiplatelet therapy alone (24.8%; 95% CI, 24.3-25.3) or subtherapeutic warfarin (25.8%; 95% CI, 25-26.6), according to the researchers.
In-hospital mortality rates were also lower in those assigned therapeutic warfarin (6.4%; 95% CI, 5.8-7) or nonvitamin K antagonist oral anticoagulants (6.3%; 95% CI, 5.7-6.8) than in patients assigned no antithrombotic therapy (9.3%; 95% CI, 8.9-9.6), antiplatelet therapy alone (8.1%; 95% CI, 7.8-8.3) or subtherapeutic warfarin (8.8%; 95% CI, 8.3-9.3), Xian and colleagues wrote.
After adjustment for potential confounders, Xian and colleagues determined that compared with no antithrombotic therapy, use of therapeutic warfarin, nonvitamin K antagonist oral anticoagulants or antiplatelet therapy was linked to reduced odds of moderate or severe stroke (adjusted OR for therapeutic warfarin = 0.56; 95% CI, 0.51-0.6; adjusted OR for nonvitamin K antagonist oral anticoagulants = 0.65; 95% CI, 0.61-0.71; adjusted OR for antiplatelet therapy = 0.88; 95% CI, 0.84-0.92) and in-hospital mortality (adjusted OR for therapeutic warfarin = 0.75; 95% CI, 0.67-0.85; adjusted OR for nonvitamin K antagonist oral anticoagulants = 0.79; 95% CI, 0.72-0.88; adjusted OR for antiplatelet therapy = 0.83; 95% CI, 0.78-0.88).
“Despite numerous international guideline recommendations, many patients fail to receive proper treatment for stroke prevention,” the researchers wrote. – by Erik Swain
Disclosure : Xian reports receiving institutional research funding from the American Heart Association, Daiichi Sankyo, Genentech and Janssen Pharmaceuticals. Please see the full study for a list of the other researchers’ relevant financial disclosures.
Click Here to Manage Email Alerts