Anticoagulation therapy in patients with stroke and atrial fibrillation: a registry-based study of acute stroke care in Surrey, UK

Abstract

IntroductionBecause of their high risk of stroke, anticoagulation therapy is recommended for most patients with atrial fibrillation (AF). The present study evaluated the use of anticoagulants in the community and in a hospital setting for patients with AF and its associations with stroke.MethodsPatients admitted with stroke to four major hospitals in County of Surrey, England were surveyed in the 2014–2016 Sentinel Stroke National Audit Programme. Descriptive statistics was used to summarise subject characteristics and χ² test to assess differences between categorical variables.ResultsA total of 3309 patients, 1656 men (mean age: 73.1 years±SD 13.2) and 1653 women (79.3 years±13.0) were admitted with stroke (83.3% with ischaemic, 15.7% haemorrhagic stroke and 1% unspecified). AF occurred more frequently (χ2=62.4; p<0.001) among patients admitted with recurrent (30.2%) rather than with first stroke (17.1%). There were 666 (20.1%) patients admitted with a history of AF, among whom 304 (45.3%) were anticoagulated, 279 (41.9%) were untreated and 85 (12.8%) deemed unsuitable for anticoagulation. Of the 453 patients with history of AF admitted with a first ischaemic stroke, 138 (37.2%) were on anticoagulation and 41 (49.6%) were not (χ2 = 6.3; p<0.043) and thrombolysis was given more frequently for those without prior anticoagulation treatment (16.1%) or unsuitable for anticoagulation (23.6%) compared with those already on anticoagulation treatment (8.3%; χ2=10.0; p=0.007). Of 2643 patients without a previous history of AF, 171 (6.5%) were identified with AF during hospitalisation. Of patients with AF who presented with ischaemic stroke who were not anticoagulated or deemed unsuitable for anticoagulation prior to admission, 91.8% and 75.0%, respectively, were anticoagulated on discharge.ConclusionsThe study highlights an existing burden for patients with stroke and reflects inadequate treatment of AF which results in an increased stroke burden. There is significant scope to improve the rates of anticoagulation.

A retrospective cohort study of oral anticoagulant treatment in patients with acute coronary syndrome and atrial fibrillation

“…Patients with ACS and AF have a poor prognostic outcome, including a higher risk of stroke 5–7. Antithrombotic treatment with oral anticoagulants (OACs), such as warfarin or non-vitamin K antagonist oral anticoagulants (NOACs), is a cornerstone in the prevention of ischaemic stroke in patients with AF 8 9. However, for patients with AF presenting with acute myocardial infarction (AMI) or coronary artery disease, undergoing percutaneous coronary intervention (PCI), it poses a great challenge with regard to the management of antithrombotic therapy 10.…”

Prestroke Disability Predicts Adverse Poststroke Outcome

“…The data comprise clinical characteristics and care quality of patients admitted to acute care hospitals in England and Wales [13]. Data from the present study were gathered from the time of admission up to six months after stroke in patients admitted to four major UK hyperacute stroke centres in South East England between January 2014 and February 2016 [14,15].…”

“…Demographic data were collected and documented by stroke consultants and nurse specialists; including age at arrival, gender and coexisting morbidities (atrial fibrillation, hypertension, congestive heart failure, diabetes mellitus and previous stroke) [13][14][15].…”

“…Stroke was diagnosed based on clinical presentation and brain imaging [14,15]. The severity of stroke symptoms at arrival was assessed by the National Institutes of Health for Stroke Scale (NIHSS) with a score range from no symptoms to severe stroke symptoms (NIHSS score=0 to 42).…”

“…Dichotomisation was applied for atrial fibrillation, congestive heart failure, hypertension and diabetes, type of stroke, and in-patient infections and mortality according to the presence or absence of history of the condition. Prolonged length of stay (LOS) on HASUs was defined as those who stayed longer than three weeks (4 th quartile) [14,15]. Pre-stroke mRS was categorised into five groups: group 1, mRS score = 0; group 2, mRS score = 1; group 3, mRS score = 2; group 4, mRS = 3; and group 5, mRS score = 4 or 5 (these last two mRS categories were grouped together due to small numbers).…”