Nav: Home

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

March 14, 2017

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.
-end-
"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.

The JAMA Network Journals

Related Stroke Articles:

Retraining the brain to see after stroke
A new study out today in Neurology, provides the first evidence that rigorous visual training restores rudimentary sight in patients who went partially blind after suffering a stroke, while patients who did not train continued to get progressively worse.
Catheter ablations reduce risks of stroke in heart patients with stroke history, study finds
Atrial fibrillation patients with a prior history of stroke who undergo catheter ablation to treat the abnormal heart rhythm lower their long-term risk of a recurrent stroke by 50 percent, according to new research from the Intermountain Medical Center Heart Institute.
Imaging stroke risk in 4-D
A new MRI technique developed at Northwestern University detects blood flow velocity to identify who is most at risk for stroke, so they can be treated accordingly.
Biomarkers may help better predict who will have a stroke
People with high levels of four biomarkers in the blood may be more likely to develop a stroke than people with low levels of the biomarkers, according to a study published in the Aug.
Pre-stroke risk factors influence long-term future stroke, dementia risk
If you had heart disease risk factors, such as high blood pressure, before your first stoke, your risk of suffering subsequent strokes and dementia long after your initial stroke may be higher.
Intervention methods of stroke need to focus on prevention for blacks to reduce stroke mortality
Blacks are four times more likely than their white counterparts to die from stroke at age 45.
Study shows area undamaged by stroke remains so, regardless of time stroke is left untreated
A study led by Achala Vagal, M.D., associate professor at the University of Cincinnati College of Medicine and a UC Health radiologist, looked at a group of untreated acute stroke patients and found that there was no evidence of time dependence on damage outcomes for the penumbra, or tissue that is at risk of progressing to dead tissue but is still salvageable if blood flow is returned in a stroke, but rather an association with collateral flow -- or rerouting of blood through clear vessels.
Immediate aspirin after mini-stroke substantially reduces risk of major stroke
Using aspirin urgently could substantially reduce the risk of major strokes in patients who have minor 'warning' events.
SAGE launches the European Stroke Journal with the European Stroke Organisation
SAGE, a world leading independent and academic publisher, is delighted to announce the launch of the European Stroke Journal, the flagship journal of the European Stroke Organisation.
The S-stroke or I-stroke?
The year 2016 is an Olympic year. Developments in high-performance swimwear for swimming continue to advance, along with other areas of scientific research.

Related Stroke Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Changing The World
What does it take to change the world for the better? This hour, TED speakers explore ideas on activism—what motivates it, why it matters, and how each of us can make a difference. Guests include civil rights activist Ruby Sales, labor leader and civil rights activist Dolores Huerta, author Jeremy Heimans, "craftivist" Sarah Corbett, and designer and futurist Angela Oguntala.
Now Playing: Science for the People

#520 A Closer Look at Objectivism
This week we broach the topic of Objectivism. We'll be speaking with Keith Lockitch, senior fellow at the Ayn Rand Institute, about the philosophy of Objectivism as it's taught through Ayn Rand's writings. Then we'll speak with Denise Cummins, cognitive scientist, author and fellow at the Association for Psychological Science, about the impact of Objectivist ideology on society. Related links: This is what happens when you take Ayn Rand seriously Another Critic Who Doesn’t Care What Rand Thought or Why She Thought It, Only That She’s Wrong Quote is from "A Companion to Ayn Rand"