Undertreatment of Anticoagulant Therapy in Hospitalized Acute Ischemic Stroke Patients With Atrial Fibrillation

Abstract

BackgroundThis study aimed to investigate the prevalence and factors associated with the initiation of oral anticoagulation among patients with acute ischemic stroke (AIS) and concurrent atrial fibrillation (AF) at discharge in China.MethodsWe continuously included hospitalized patients with AIS with an AF diagnosis registered in the computer-based Online Database of Acute Stroke Patients for Stroke Management Quality Evaluation (CASE II) from January 2016 to December 2020 and divided them into a and non-anticoagulant groups according to the medications at discharge. Binary logistic regression was used to determine the factors associated with the prescription of anticoagulants in patients with AF.ResultsA total of 16,162 patients were enrolled. The mean age was 77 ± 9 years, 8,596 (53.2%) were males, and the median baseline National Institute of Health Stroke Scale score was 5 (2–12). Of the 14,838 patients without contraindications of antithrombotic therapy, 6,335 (42.7%) patients were initiated with anticoagulation treatment at discharge. Prior history of hemorrhagic stroke (OR 0.647, p < 0.001) and gastrointestinal bleeding (OR 0.607, p = 0.003) were associated with a lower rate of anticoagulation at discharge. Patients with any intracranial hemorrhage (OR 0.268, p < 0.001), gastrointestinal bleeding (OR 0.353, p < 0.001), or pneumonia during hospitalization (OR 0.601, p < 0.001) were less likely to receive anticoagulants at discharge. Among 7,807 patients with previously diagnosed AF and high risk of stroke (CHA2DS2-VASc ≥2), only 1,585 (20.3%) had been receiving anticoagulation treatment prior to the onset of stroke. However, the mean international normalized ratio (INR) was 1.5 on the first test during hospitalization in patients receiving warfarin. Patients complicated with a previous history of ischemic stroke/transient ischemic attack (TIA; OR 2.303, p < 0.001) and peripheral artery disease (OR 1.456, p = 0.003) were more common to start anticoagulants.ConclusionsLess than half of patients with AIS and concurrent AF initiated guideline-recommended oral anticoagulation at discharge, while only 20% of patients with previously diagnosed AF with a high risk of stroke had been using anticoagulants prior to the onset of stroke, which highlights a large care gap in hospitalized stroke patients and the importance of AF management.

Efficacy and Safety of Anticoagulant Therapy Versus Antiplatelet Therapy in Acute Ischemic Stroke Patients with Atrial Fibrillation

“…21 Only 52.2% of AF patients were treated with anticoagulants following AIS in our analysis, which was close to the proportion recently reported (42.7%) in patients with AIS and AF in China. 22…”

“…21 Only 52.2% of AF patients were treated with anticoagulants following AIS in our analysis, which was close to the proportion recently reported (42.7%) in patients with AIS and AF in China. 22 Several studies have reported the benefit of anticoagulant therapy on functional outcomes. Anticoagulants were associated with a superior functional outcome at 3 months compared to no anticoagulants in a trial of 395 patients with AF-related AIS.…”

Contemporary oral anticoagulant therapy of patients with atrial fibrillation in China: Status, obstacles, and strategies for improvement

“…In addition to intrinsic patient factors such as health literacy and knowledge regarding AF, many clinical patient-level factors could also influence OAC therapy in patients with AF. Several studies have investigated the characteristics of patients who did not take, adhere to, or persist with OAC therapy (31,46,(70)(71)(72)(73). Common patient factors integrated from the findings of previous studies were older age, non-urban residence, lower education level, lower income, history of stroke, multiple comorbidities, and antiplatelet therapy (14).…”

Development and Validation of a Dynamic Nomogram for Predicting 3-Month Mortality in Acute Ischemic Stroke Patients with Atrial Fibrillation

“…[8][9][10][11] Consequently, the potential benefits of lowering mortality risk through anticoagulant therapy have not been fully realized. 12,13 Therefore, the early identification of factors influencing mortality risk is of paramount importance to facilitate timely interventions and prolong patient longevity.…”