Aug 12, 2015

Underuse of anticoagulation in stroke patients with atrial fibrillation - the FibStroke Study

European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies
Antti PalomäkiK E Juhani Airaksinen

Abstract

Current guidelines recommend oral anticoagulation (OAC) for patients with atrial fibrillation (AF) and increased risk of thromboembolic events. The reasons for not using OAC in AF patients suffering stroke or transient ischaemic attack (TIA) were assessed. This retrospective registry included 3404 patients with previously diagnosed AF who suffered a total of 2955 ischaemic strokes and 895 TIAs during 2003-2012. A CHA2 DS2 -VASc score ≥2 and a CHADS2 score ≥2 was observed in 3590 (93.2%) and in 2784 (72.3%) of the events, respectively. Of the high-risk patients (CHADS2 ≥2) only 55.1% were on OAC before the onset of stroke or TIA. The most frequently documented reasons for withholding OAC were infrequent paroxysms of AF (14%), previous bleeding episodes (13%) and the patient's decline/independent discontinuation of treatment (9%). Moreover, patients with paroxysmal AF (40% using OAC), previous bleeding (26% using OAC) and alcohol abuse (30% using OAC) were using OAC significantly less often than patients without these characteristics. A significant increase in the proportion of high-risk patients using OAC from 49% in 2003 to 65% in 2012 was seen. Underuse of anticoagulation is a common contributor to ischaemic strokes and TIA ep...Continue Reading

Mentioned in this Paper

Episodic Ataxia Type 1
Recommendations or Guidelines
Negative Regulation of Coagulation
Alcohol Abuse
Decreased Coagulation Activity [PE]
Atrial Fibrillation
Thromboembolism
Cerebrovascular Accident
Transient Ischemic Attack
Vascular Diseases

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