Preadmission Oral Anticoagulant Treatment and Clinical Outcome Among Patients Hospitalized With Acute Stroke and Atrial Fibrillation

Abstract

Background and Purpose-Preadmission oral anticoagulant treatment (OAT) has been linked with less severe stroke and a better outcome in patients with atrial fibrillation. However, the existing studies have methodological limitations and have, with one exception, not included hemorrhagic strokes. We performed a nationwide historic follow-up study using data from population-based healthcare registries to assess the effect of preadmission OAT on stroke outcomes further. Methods-We identified 11 356 patients with atrial fibrillation admitted to hospital with acute stroke (including ischemic stroke and intracerebral hemorrhage) between 2003 and 2009. Propensity score-matched analyses were used to compare stroke severity (Scandinavian Stroke Scale score) and mortality among 2175 patients with preadmission OAT and 2175 patients without preadmission OAT. Results-A total of 2492 (21.9%) patients received OAT at the time of their stroke. Preadmission OAT was associated with a lower risk of severe stroke (Scandinavian Stroke Scale score at time of admission, <30 point; propensity score-matched odds ratio, 0.74; 95% confidence interval, 0.63-0.86) and lower 30-day mortality rate (propensity score-matched adjusted odds ratio, 0.83; 95% confidence interval, 0.71-0.98). Conclusions-Only

Adequacy of preadmission oral anticoagulation with vitamin K antagonists and ischemic stroke severity and outcome in patients with atrial fibrillation

“…Approximately only one-third of patients with AF in our study was receiving VKAs, a rate which is in line with previous reports [14][15][16][17][18][19]27]. Notably, the CHA 2 DS 2 -VASC score prior the incident stroke was C2 in all patients with AF in our study, suggesting that all should have been on oral anticoagulants [28].…”

“…In contrast, larger studies reported smaller neurological deficit in patients with therapeutic anticoagulation at stroke onset [14][15][16][17]. Therefore, it is possible that our study did not have adequate power to reveal a beneficial effect of well-controlled treatment with warfarin on stroke severity.…”

“…In contrast with the well-proven benefits of VKAs in preventing stroke in patients with AF, it is unclear whether these agents also affect stroke severity and outcome [14][15][16][17][18][19][20]. Some studies reported less severe strokes in patients who were optimally anticoagulated prior stroke [14][15][16][17] whereas others found no effect [18].…”

“…Some studies reported less severe strokes in patients who were optimally anticoagulated prior stroke [14][15][16][17] whereas others found no effect [18]. Accordingly, some reports suggested better outcomes in patients with therapeutic anticoagulation before stroke [16,19,20] but others did not confirm this benefit [15,17].…”

“…Some studies reported less severe strokes in patients who were optimally anticoagulated prior stroke [14][15][16][17] whereas others found no effect [18]. Accordingly, some reports suggested better outcomes in patients with therapeutic anticoagulation before stroke [16,19,20] but others did not confirm this benefit [15,17]. Even though novel anticoagulants have been recently introduced for the management of AF and appear to have comparable or even superior safety and efficacy compared with warfarin [21][22][23], the majority of patients with AF still receive warfarin [11,24].…”