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

Τζιόμαλος, Κωνσταντίνος; Giampatzis, Vasilios; Bouziana, Stella D.; Spanou, Marianna; Kostaki, Stavroula; Papadopoulou, Maria; Dourliou, Vasiliki; Sofogianni, Areti; Savopoulos, Christos; Hatzitolios, Apostolos

doi:10.1007/s11239-015-1262-y

Cited by 11 publications

(6 citation statements)

References 33 publications

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“…In real world clinical practice, the economic costs should also be accounted for. 18 In previous studies, therapeutic warfarin was associated with reduced severity of IS at presentation and reduced disability or death at discharge in patients with AF, 19 , 20 which is consistent with the current study. We also found that the direct costs for patients with IS who had undergone warfarin treatment before admission were less than those for patients who did not undergo warfarin treatment.…”

Section: Discussionsupporting

confidence: 91%

In‐hospital direct costs for thromboembolism and bleeding in Chinese patients with atrial fibrillation

Chang

Liu³

et al. 2018

Chronic Diseases and Translational Medicine

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ObjectiveLimited data are available on the direct costs of hospitalization owing to thromboembolism and bleeding in patients with atrial fibrillation (AF) in China. Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic strategies. This study aimed to provide detailed data regarding in-hospital direct costs for these patients, compare the costs at different scenarios, and identify independent factors that may predict the costs.MethodsWe collected data regarding in-hospital direct costs among patients with AF who were hospitalized owing to ischemic stroke (IS), transient ischemic attack (TIA), intracranial hemorrhage (ICH), or major gastrointestinal bleeding. All data were collected from 7 representative tertiary referral hospitals and 3 secondary care hospitals from December 2009 to October 2014.ResultsIn total, 312 eligible patients with thromboembolism and 143 patients with major bleeding were identified, and their hospital charts were reviewed. The median in-hospital direct costs were 17,857 Chinese Yuan (CNY) for IS and 16,589 CNY for TIA (equivalent to 2907 US dollars and 2701 US dollars, respectively). For patients with major bleeding, the costs were 27,924 CNY for ICH and 18,196 CNY for major gastrointestinal bleeding (equivalent to 4546 US dollars and 2962 US dollars, respectively). The direct costs were mainly driven by medications, which accounted for approximately 33.4%–36.1% in different groups of patients. The direct costs were highly related to the hospital level and National Institutes of Health Stroke Scale scores in patients with thromboembolism; in patients with ICH, the factors included hospital level, warfarin treatment before admission, and prior hospitalization for stroke.ConclusionsGiven the high prevalence, AF-related thromboembolism and bleeding impose considerable economic burden on the Chinese society. Efforts to improve the management of AF may confer substantial economic benefits.

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Section: Discussionsupporting

confidence: 91%

In‐hospital direct costs for thromboembolism and bleeding in Chinese patients with atrial fibrillation

Chang

Liu³

et al. 2018

Chronic Diseases and Translational Medicine

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“…Notably, AF patients reap additional benefits from OACs, apart from ischemic stroke risk reduction. AF patients on warfarin with an INR ≥ 2 immediately before stroke have smaller brain infarcts 24,25 and lower stroke severity, 24 recurrence, 26 disability, 16,24,27–29 and mortality 16,27,29,30 relative to patients only taking antiplatelet agents, no antithrombotic drugs, or warfarin with an INR < 2.…”

Section: Benefits Of Oral Anticoagulants For Af Patientsmentioning

confidence: 99%

Decision-making interventions to stop the global atrial fibrillation-related stroke tsunami

Cerasuolo

Montero‐Odasso

Ibáñez

et al. 2017

International Journal of Stroke

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Atrial fibrillation affects 33.5 million people worldwide and its prevalence is expected to double by 2050 because of the aging population. Atrial fibrillation confers a 5-fold higher risk of ischemic stroke compared to sinus rhythm. We present our view of the role of shared medical decision-making to combat global underutilization of oral anticoagulation for stroke prevention in atrial fibrillation patients. Oral anticoagulation underuse is widespread as it is present within atrial fibrillation patients of all risk strata and in countries across all income levels. Reasons for oral anticoagulation underuse include but are probably not limited to poor risk stratification, over-interpretation of contraindications, and discordance between physician prescription preferences and actual administration. By comparing a catastrophic event to the consequences of atrial fibrillation related strokes, it may help physicians and patients understand the negative outcomes associated with oral anticoagulation under-utilization and the magnitude to which oral anticoagulations neutralize atrial fibrillation burden.

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“…It is well established that single antiplatelet treatment has limited efficacy in reducing cardiovascular events in patients with AF compared with placebo [23,24] and therefore, it is recommended only in patients with AF who have contraindications to oral anticoagulants or who refuse treatment with the latter agents [25] . Moreover, several studies showed that antiplatelet treatment prior to stroke in patients with AF does not affect the severity of stroke or the short-term outcome [26][27][28][29][30] . Therefore, we included in our analyses only patients without AF, prosthetic valve or hemodynamically relevant heart valve disease and we showed that clopidogrel attenuates the severity of non-cardioembolic stroke.…”

Section: Discussionmentioning

confidence: 99%

Treatment with Clopidogrel Prior to Acute Non-Cardioembolic Ischemic Stroke Attenuates Stroke Severity

Τζιόμαλος

Giampatzis²,

Bouziana³

et al. 2016

Cerebrovasc Dis

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Background: Clopidogrel reduces the risk of non-cardioembolic ischemic stroke, but it is unclear whether it affects the severity and outcome of stroke. We aimed at evaluating the effect of prior treatment with clopidogrel on acute non-cardioembolic ischemic stroke severity and in-hospital outcome. Methods: We prospectively studied 608 consecutive patients (39.5% males, age 79.1 ± 6.6 years) who were admitted with acute ischemic stroke. The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). Severe stroke was defined as NIHSS ≥21. The outcome was assessed using the dependency rates that prevailed at the time of discharge (i.e. modified Rankin scale between 2 and 5) and with in-hospital mortality. Results: At admission, 397 patients did not have atrial fibrillation or heart valve disease. Among these 397 patients, 69 were receiving monotherapy with clopidogrel prior to stroke, 69 were receiving monotherapy with aspirin and 236 patients were not on any antiplatelet treatment. The prevalence of severe stroke was lower in patients who were receiving clopidogrel than in patients who were receiving aspirin and patients who were not on antiplatelets (1.4, 13.0 and 11.0%, respectively; p < 0.05). Independent predictors of severe stroke at admission were male gender (relative risk (RR) 0.31, 95% CI 0.12-0.78, p < 0.05) and treatment with clopidogrel prior to stroke compared with no antiplatelet treatment (RR 0.13, 95% CI 0.02-0.97, p < 0.05). Treatment with aspirin prior to stroke did not predict severe stroke compared with no antiplatelet treatment (RR 1.24, 95% CI 0.51-2.98, p = NS). The rate of dependency at discharge did not differ between patients who were receiving clopidogrel, patients who were receiving aspirin and those who were not on antiplatelets (57.9, 47.8 and 59.7%, respectively; p = NS). Independent predictors of dependency at discharge were age (RR 1.12, 95% CI 1.05-1.19, p < 0.001) and NIHSS at admission (RR 1.67, 95% CI 1.46-1.92, p < 0.001). In-hospital mortality rate also did not differ between patients who were receiving clopidogrel, patients who were receiving aspirin and those who were not on antiplatelets (4.3, 4.3 and 5.0%, respectively; p = NS). The only independent predictor of in-hospital mortality was NIHSS at admission (RR 1.22, 95% CI 1.14-1.30, p < 0.001). Conclusions: Treatment with clopidogrel prior to acute non-cardioembolic ischemic stroke attenuates the severity of stroke at admission but does not appear to affect the functional outcome at discharge or the in-hospital mortality of these patients.

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

Cited by 11 publications

References 33 publications

In‐hospital direct costs for thromboembolism and bleeding in Chinese patients with atrial fibrillation

In‐hospital direct costs for thromboembolism and bleeding in Chinese patients with atrial fibrillation

Decision-making interventions to stop the global atrial fibrillation-related stroke tsunami

Treatment with Clopidogrel Prior to Acute Non-Cardioembolic Ischemic Stroke Attenuates Stroke Severity

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