Stroke prevention in atrial fibrillation: physicians’ attitudes to anticoagulation in older people

Vasishta, Sanjeev; Toor, Farooque; Johansen, Antony; Hasan, Mahmudul

doi:10.1016/s0167-4943(01)00184-4

Cited by 28 publications

(18 citation statements)

References 16 publications

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“…31 The older age of our cohort may explain some of our findings because there is frequently concern about prescribing warfarin to elderly patients. 19,20,[32][33][34] However, safety of anticoagulation in the elderly has been established, 24,25,35 and in a recent randomized trial of patients with atrial fibrillation aged Ն75 years, warfarin was associated with significantly fewer stroke events than aspirin without an increase in hemorrhage risk. 36 In addition to physician factors, individual patient knowledge and preferences have an impact on adherence to anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

Potentially Preventable Strokes in High-Risk Patients With Atrial Fibrillation Who Are Not Adequately Anticoagulated

Gladstone

Bui

Fang

et al. 2009

Stroke

361

232

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Background and Purpose-Warfarin is the most effective stroke prevention medication for high-risk individuals with atrial fibrillation, yet it is often underused. This study examined the magnitude of this problem in a large contemporary, prospective stroke registry. Methods-We analyzed data from the Registry of the Canadian Stroke Network, a prospective database of consecutive patients with stroke admitted to 12 designated stroke centers in Ontario (2003Ontario ( to 2007. We included patients admitted with an acute ischemic stroke who (1) had a known history of atrial fibrillation; (2) were classified as high risk for systemic emboli according to published guidelines; and (3) had no known contraindications to anticoagulation. Primary end points were the use of prestroke antithrombotic medications and admission international normalized ratio. Results-Among patients admitted with a first ischemic stroke who had known atrial fibrillation (nϭ597), strokes were disabling in 60% and fatal in 20%. Preadmission medications were warfarin (40%), antiplatelet therapy (30%), and no antithrombotics (29%). Of those taking warfarin, three fourths had a subtherapeutic international normalized ratio (Ͻ2.0) at the time of stroke admission. Overall, only 10% of patients with acute stroke with known atrial fibrillation were therapeutically anticoagulated (international normalized ratio Ն2.0) at admission. In stroke patients with a history of atrial fibrillation and a previous transient ischemic attack or ischemic stroke (nϭ323), only 18% were taking warfarin with therapeutic international normalized ratio at the time of admission for stroke, 39% were taking warfarin with subtherapeutic international normalized ratio, and 15% were on no antithrombotic therapy. Conclusions-In high-risk patients with atrial fibrillation admitted with a stroke, and who were candidates for anticoagulation, most were either not taking warfarin or were subtherapeutic at the time of ischemic stroke. Many were on no antithrombotic therapy. These findings should encourage greater efforts to prescribe and monitor appropriate antithrombotic therapy to prevent stroke in individuals with atrial fibrillation.

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Section: Discussionmentioning

confidence: 99%

Potentially Preventable Strokes in High-Risk Patients With Atrial Fibrillation Who Are Not Adequately Anticoagulated

Gladstone

Bui

Fang

et al. 2009

Stroke

361

232

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“…Mit der zunehmenden Alterung unserer Gesellschaft wird eine steigende Prävalenz von Vorhofflimmern erwartet. Insbesondere bei diesen älteren Patienten, die von einer Behandlung mit OAT profitieren würden, werden OAT zu selten verabreicht [83]. Zwar ist das zunehmende Alter ein Risikofaktor für eine ICB, jedoch überwiegen die positiven Aspekte einer OAT im Hinblick auf Verringerung der Gefahr einer zerebralen Ischämie die negativen Risiken der ICB [35].…”

Section: Epidemiologieunclassified

Antikoagulanzienassoziierte Hirnblutungen

Jüttler

Hug

et al. 2006

Nervenarzt

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Intracerebral hemorrhage (ICH) is the most serious complication of oral anticoagulant therapy (OAT). The growing use of OAT has resulted in an increase of fatal ICH. The mortality rate is about 65%, and most of the surviving patients remain disabled. While improvements in the treatment of spontaneous ICH have recently been described, there are no internationally accepted guidelines for managing patients with OAT-ICH. Therefore, identifying effective treatments is essential for improving clinical outcome. This article reviews the epidemiology of OAT-ICH, its pathophysiology, and current treatment options and discusses open questions with particular respect to more recent pharmacological therapies.

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“…However prophylactic oral anticoagulation (OAC) treatment is not, by clinicians, always thought to be suitable in an older, frail patient with present and maybe dominating co morbidities such as cognitive impairment or giddiness and high risk of falling, where the fear of potential risk of OAC with intracranial hemorrhage is believed to exceed the benefits, following the reduced risk of cardio-embolic stroke (Vasishta et al, 2001). Recently it has been shown that the benefits of OAC are of great importance especially for an older patient with AF who has a greater risk of cardio-embolic stroke than a middle aged patient with AF.…”

Section: Introductionmentioning

confidence: 99%

Atrial fibrillation (AF) and co-morbidity in elderly. A population based survey of 85 years old subjects

Rådholm

Östgren

Alehagen

et al. 2011

Archives of Gerontology and Geriatrics

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Atrial fibrillation (AF) and co-morbidity in elderly. A population based survey of 85 years old subjects., 2011, Archives of gerontology and geriatrics (Print), (52) AbstractThe occurrence of AF increases sharply with age. The aim of this study was to explore and compare prevalent co morbidity and self estimated health related quality of life in subjects with AF versus subjects with sinus rhythm or pacemaker in 85 years old subjects. We analyzed data from a population of 336 eighty five years old subjects participating in the Elderly in Linköping Screening Assessment (ELSA-85) study. Medical history was obtained from postal questionnaire, medical records and during medical examination that included a physical examination, cognitive tests, non fasting venous blood samples and electrocardiographic (ECG) examination. 19% had an ECG showing AF. There were very few significant differences regarding medical history, self-estimated quality of life (QoL), laboratory-and examination findings and use of public health care between the AF group and the non-AF group. The study showed that that the population of 85 years old subjects with AF was surprisingly healthy in terms of prevalent co-existing medical conditions, healthcare contacts and overall health related quality of life (HRQoL). We conclude that elderly patients with AF do not in general have increased co morbidity than subjects without AF.

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Stroke prevention in atrial fibrillation: physicians’ attitudes to anticoagulation in older people

Cited by 28 publications

References 16 publications

Potentially Preventable Strokes in High-Risk Patients With Atrial Fibrillation Who Are Not Adequately Anticoagulated

Potentially Preventable Strokes in High-Risk Patients With Atrial Fibrillation Who Are Not Adequately Anticoagulated

Antikoagulanzienassoziierte Hirnblutungen

Atrial fibrillation (AF) and co-morbidity in elderly. A population based survey of 85 years old subjects

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