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Underuse of anti-clotting therapies common among patients with atrial fibrillation who have a stroke

The JAMA Network Journals

Inadequate use of anticoagulation therapies was prevalent among patients with atrial fibrillation who experienced a stroke, according to a study appearing in the March 14 issue of JAMA.

Atrial fibrillation (AF) is an independent risk factor for stroke, increases stroke risk by a factor of 4 to 5, and accounts for 10 percent to 15 percent of all ischemic strokes. While the burden of AF-related stroke is high, AF is a potentially treatable risk factor. Numerous studies have demonstrated that vitamin K antagonists, such as warfarin, or non-vitamin K antagonist oral anticoagulants (NOACs), reduce the risk of ischemic stroke. Based on these data, current guidelines recommend adjusted-dose warfarin or NOACs over aspirin for stroke prevention in high-risk patients with AF.

Ying Xian, M.D., Ph.D., of the Duke University Medical Center, Durham, N.C., and colleagues conducted a study that included 94,474 patients who had an acute ischemic stroke and known history of AF admitted to hospitals participating in the Get With the Guidelines-Stroke program.

Of these patients:

  • 84 percent were not receiving therapeutic anticoagulation prior to stroke
  • 30 percent were not receiving any antithrombotic treatment prior to stroke
  • 7.6 percent were receiving therapeutic warfarin
  • 8.8 percent were receiving NOACs
  • 40 percent were receiving antiplatelet therapy only

Therapeutic anticoagulation was associated with lower odds of moderate or severe stroke and lower odds of in-hospital mortality.

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"Atrial fibrillation is a highly prevalent and important, but treatable, risk factor for stroke. Despite numerous international guideline recommendations, many patients fail to receive proper treatment for stroke prevention," the authors write. (doi:10.1001/jama.2017.1371; the study is available pre-embargo at the For the Media website)

Editor's Note: This work was supported by an award from the Patient-Centered Outcomes Research Institute. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.

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