Recurrent vascular events in patients with ischemic stroke/TIA and atrial fibrillation in relation to secondary prevention at hospital discharge

Tentschert, S.; Parigger, Silvia; Dorda, Veronika; Bittner, Kathrin; Unterbuchschachner, Daniel; Greisenegger, Stefan; Wimmer, Romana; Brücke, Thomas; Lang, Wilfried; Lalouschek, Wolfgang

doi:10.1007/s00508-004-0259-x

Cited by 7 publications

(7 citation statements)

References 3 publications

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“…The lower rate of OAC use in older adults may reflect an uncertainty about the relative efficacy and safety of OAC in these patients. However, available data suggest that despite a higher rate of hemorrhages a net benefit of OAC remains [17, 25, 26, 28]. Conversely, the increased probability to receive OAC at discharge when patients had a medical history of angina pectoris may reflect the opinion that such patients have an increased risk of stroke.…”

Section: Discussionmentioning

confidence: 96%

“…Nevertheless, the result of the logistic regression analysis showed that some patients having a so-called potential contraindication were receiving OAC at discharge, most of them having a large infarct. Therefore potential contraindications explain only a small part of the underutilization of OAC [12,13,14,15,16,17]. …”

Section: Discussionmentioning

confidence: 99%

“…The reasons why patients do not receive the most appropriate treatment in primary prevention are well known nowadays [11]. However, factors influencing the prescription of OAC at discharge after an ischemic stroke or TIA in NVAF patients have only partially been investigated so far [12,13,14,15,16,17]. …”

Section: Introductionmentioning

confidence: 99%

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Secondary Prevention of Stroke in Patients with Atrial Fibrillation: Factors Influencing the Prescription of Oral Anticoagulation at Discharge

Deplanque

Leys²,

Parnetti³

et al. 2006

Cerebrovasc Dis

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Background: Oral anticoagulation (OAC) is the only treatment that has shown a significant benefit to reduce the risk of recurrence in patients with ischemic stroke and nonvalvular atrial fibrillation (NVAF). However, OAC is still underused, even at discharge from neurological centers. The objective of this study was to identify the reasons underlying the prescription of OAC at discharge after an ischemic stroke in patients with NVAF. Methods: We investigated the reasons why ischemic stroke patients with NVAF were not treated with OAC at discharge from 40 centers located in 5 European countries (Austria, Belgium, France, Italy, and Portugal). Results: Of 320 ischemic stroke survivors at discharge, 186 (58.1%) received OAC, while 260 (81.3%) patients were theoretically eligible according to guidelines and the absence of contraindications. There were significant differences between countries and the logistic regression analysis found being already under OAC before stroke, having no leukoaraiosis, having no potential contraindication, being younger than 75 years, being married and suffering from angina pectoris as independent predictors of being discharged under OAC. Conclusion: This study suggests that besides patient-related factors, the prescription of OAC is also significantly influenced by the social environment and national practices.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Secondary Prevention of Stroke in Patients with Atrial Fibrillation: Factors Influencing the Prescription of Oral Anticoagulation at Discharge

Deplanque

Leys²,

Parnetti³

et al. 2006

Cerebrovasc Dis

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“…10.2% of acute stroke patients with AF were discharged without any antithrombotic medication, the reasons for which were not further investigated. Almost 90% of AF patients discharged on OAC were still on OAC after 1–2 years, which is a quite good adherence compared to other antithrombotic medications in secondary prevention [18, 19]. The quality of OAC at follow-up was moderate, and more than half of all patients reported at least one coagulation parameter outside the therapeutic window at some time during the preceding 3 months.…”

Section: Discussionmentioning

confidence: 97%

Adherence and Quality of Oral Anticoagulation in Cerebrovascular Disease Patients with Atrial Fibrillation

et al. 2008

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Background/Aims: Low rates and poor quality of oral anticoagulation (OAC) have been reported in patients with atrial fibrillation (AF). We therefore sought to investigate the prescription patterns at discharge, adherence and quality of OAC in cerebrovascular disease patients with AF. Methods: Consecutive ischemic stroke (IS) and transient ischemic attack (TIA) patients were prospectively documented in 11 German stroke centers. A central telephone follow-up after 1–2 years assessed the current antithrombotic medication and results of coagulation checks. Results: Of 1,463 surviving patients with AF, 30.5% were discharged on OAC and 13.9% on high-dose heparin. Of 329 AF patients discharged on OAC and with consent for follow-up, 88.7% of surviving patients were still on OAC at the follow-up. Of these, 52.7% reported coagulation values out of the therapeutic range during the preceding 3 months. A recurrent IS was seen in 9 patients (2.1%/year) and an intracranial hemorrhage in 2. Conclusion: We found an important underuse of OAC following TIA or IS mainly in older patients and with greater stroke-related disability. Although the reported coagulation checks showed an only moderate rate within therapeutic ranges, safety and efficacy of OAC in this cohort seem comparable to previous randomized and observational trials in AF patients.

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“…Still, only half of all patients with AF are adequately anti-coagulated. [31–33] Compliance compromises adequate anticoagulation in many cases, but still many eligible candidates refuse anticoagulation because of fear of hemorrhage or hemorrhagic conversion of the infarct. The fear of initiating anticoagulation in elderly with fall risk might be exaggerated.…”

Section: Introductionmentioning

confidence: 99%

Trends in the management of atrial fibrillation: A neurologist's perspective

Hedna

Favilla

Guerrero

et al. 2012

Journal of Cardiovascular Disease Research

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Cardiac embolism, primarily from atrial fibrillation (AF), is implicated in a quarter of all ischemic strokes. In the setting of AF, contraindications to traditional therapies can create a clinical dilemma when choosing an agent for secondary stroke prophylaxis. Newer horizons in the medical and surgical management of AF have helped us choose from a wide variety of available therapies, the best possible management. In this article, we review the current trends in AF management including newer oral anticoagulants as well as surgical devices from a neurologist's view.

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Recurrent vascular events in patients with ischemic stroke/TIA and atrial fibrillation in relation to secondary prevention at hospital discharge

Cited by 7 publications

References 3 publications

Secondary Prevention of Stroke in Patients with Atrial Fibrillation: Factors Influencing the Prescription of Oral Anticoagulation at Discharge

Secondary Prevention of Stroke in Patients with Atrial Fibrillation: Factors Influencing the Prescription of Oral Anticoagulation at Discharge

Adherence and Quality of Oral Anticoagulation in Cerebrovascular Disease Patients with Atrial Fibrillation

Trends in the management of atrial fibrillation: A neurologist's perspective

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