Anticoagulants for Preventing Stroke in Patients With Nonrheumatic Atrial Fibrillation and a History of Stroke or Transient Ischemic Attack

Saxena, Richa; Koudstaal, Peter J.

doi:10.1161/01.str.0000129900.70583.67

Cited by 19 publications

(12 citation statements)

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“…6 Despite this uncertainty, detection of AF is important, because treatment with anticoagulation decreases the annual risk of recurrent stroke by two thirds. 9 Several studies have used 24 to 72 hours of Holter monitoring to look for previously undiagnosed AF in patients with ischemic stroke. [10][11][12][13][14][15][16] A recent systematic review of these studies indicated that the yield of Holter monitoring is 4.6%.…”

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confidence: 99%

Delayed Detection of Atrial Fibrillation after Ischemic Stroke

Kamel

Lees

Lyden

et al. 2009

Journal of Stroke and Cerebrovascular Diseases

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confidence: 99%

Delayed Detection of Atrial Fibrillation after Ischemic Stroke

Kamel

Lees

Lyden

et al. 2009

Journal of Stroke and Cerebrovascular Diseases

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“…1 In clinical trials, warfarin reduces the risk of a further ischemic stroke of any type by 62% to 70%, 2 and the risk of cardioembolic infarction is reduced by 83%. 3,4 Warfarin also reduces mortality and is cost-effective in this group of patients. 5 Despite clear benefits, anticoagulant therapy continues to be underutilized.…”

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confidence: 99%

Not All Patients With Atrial Fibrillation–Associated Ischemic Stroke Can Be Started on Anticoagulant Therapy

Somerfield

Barber

Anderson

et al. 2006

Stroke

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Background and Purpose-Ischemic stroke patients in atrial fibrillation (AF) have a 10% to 20% risk of recurrent stroke.Warfarin reduces this risk by two thirds. However, warfarin is underutilized in this patient group. We performed a prospective study to determine the reasons why warfarin is not started in these patients. Methods-All patients with AF-associated ischemic stroke over a 12-month period were identified. Demographic and other data, including whether warfarin was commenced or recommended at discharge, and if not why not, were recorded. Results-Ninety-three of 412 (23%) ischemic stroke patients had paroxysmal or permanent AF. Of these patients, 17 (18%) died, 48 (52%) were discharged home, and 28 (30%) were discharged to institutional care. Only 13 of 64 (20%) patients with known AF were taking warfarin at stroke onset. Warfarin was started (or recommended) in 35 of 76 (46%) survivors. Of those not commenced on warfarin, 32 (78%) were dependent (PϽ0.001) and 23 (56%) were discharged to institutional care (PϽ0.001). Warfarin was not started because of severe disability and frailty in 13 (32%), risk of falls in 12 (30%), and limited life expectancy in 4 (10%). Conclusions-In this cohort of patients with AF, warfarin was primarily underutilized before stroke onset, and it was too late to use anticoagulation, in approximately half, once a stroke had occurred. The decision to start or continue anticoagulation requires clinical judgment and should be made on a case by case basis after a complete risk benefit assessment.

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“…Although the risk for extracranial bleedings was significantly elevated during oral anticoagulation, this was not the case for intracranial bleedings (Saxena and Koudstaal 2004). It is to expect that patients with intermittent atrial fibrillation have benefit as well.…”

Section: Anticoagulation In Cardiogenic Thrombembolic Events Recommenmentioning

confidence: 99%