Strokes attributable to underuse of warfarin and antiplatelets

Olsen, Tom Skyhøj; Rasmussen, Berit H; Kammersgaard, Lars Peter; Germer, Ulla

doi:10.1016/j.jstrokecerebrovasdis.2004.11.003

Cited by 7 publications

(8 citation statements)

References 19 publications

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“…Our results are in line with other studies. [13][14][15][16] There has been no clear contraindication to warfarin in Ϸ2 to 3 times the number of patients actually receiving it, and most estimates of the underuse of warfarin in patients with AF exceed 40%. Even in the mildest end of the stroke spectrum, the use of anticoagulation did not exceed 70% in our study population, whereas in patients with severe strokes, such usage was Ͻ50%.…”

Section: Use Of Anticoagulationmentioning

confidence: 99%

Reduced Poststroke Mortality in Patients With Stroke and Atrial Fibrillation Treated With Anticoagulants

Andersen

Olsen

2007

Stroke

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Background and Purpose-The preventive effect of anticoagulation in patients with stroke and atrial fibrillation (AF) is documented only in trials of minor stroke. Although anticoagulation reduced stroke recurrence, those trials did not demonstrate an influence of anticoagulation on survival. Methods-A nationwide registry that was started in 2001 with the aim of registering all hospitalized stroke patients in Denmark now includes 24 791 patients. We studied the survival of patients with ischemic stroke and AF with respect to anticoagulation treatment. All underwent an evaluation for stroke severity (according to the Scandinavian Stroke Scale), computed tomography scan, and an evaluation for cardiovascular risk factors.

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Section: Use Of Anticoagulationmentioning

confidence: 99%

Reduced Poststroke Mortality in Patients With Stroke and Atrial Fibrillation Treated With Anticoagulants

Andersen

Olsen

2007

Stroke

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“…Currently, the rate of anticoagulation prescription for individuals with AF remains low in elderly populations. Underuse of oral anticoagulants in AF is one of the most common examples of unadapted prescription in elderly adults . In 54 studies on warfarin therapy in high‐risk groups of individuals aged 80 and older with nonvalvular AF, the estimated prevalence of underprescription was approximately 40% .…”

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confidence: 99%

“…Underuse of oral anticoagulants in AF is one of the most common examples of unadapted prescription in elderly adults. 11,12 In 54 studies on warfarin therapy in high-risk groups of individuals aged 80 and older with nonvalvular AF, the estimated prevalence of underprescription was approximately 40%. 11 In nursing homes, anticoagulation treatment practices for residents with AF have been less extensively studied.…”

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confidence: 99%

Underuse of Oral Anticoagulation for Individuals with Atrial Fibrillation in a Nursing Home Setting in France: Comparisons of Resident Characteristics and Physician Attitude

Bahri

Roca

Lechani

et al. 2015

J American Geriatrics Society

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The prevalence of AF in a cohort of very old nursing home residents was 10%. Anticoagulation was prescribed in fewer than 50% of eligible cases despite high individual risk of stroke. Geriatric syndromes, especially falls and cognitive disorders, were the main reported contraindications for prescribing anticoagulants. Physicians caring for those residents wrongly thought that paroxysmal AF caused fewer thromboembolic events than permanent AF, which explains lower rates of anticoagulant prescription in individuals with paroxysmal AF.

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“…[22][23][24][25][26] A population based study performed in Denmark has demonstrated that the underuse of VKAs is a major determinant of cardioembolic stroke in patient with AF and could burden for 4-5% of strokes. 27 In our study less than one third of patients with known AF admitted to internal medicine wards of Tuscany for acute stroke took VKAs for stroke prevention (28.3%) with a gap between patients needing VKAs (CHADS 2 ≥2, 86.7%) and patients really treated of around 60% (58.4%) and the underuse of VKAs increased in patients with major risk of stroke reaching percentage less than 25% in patients with CHADS 2 score ≥4. Moreover the majority of patients who took VKAs were not protected for stroke risk due to suboptimal anticoagulation control.…”

Section: Resultsmentioning

confidence: 52%

Stroke prevention in atrial fibrillation: findings from Tuscan FADOI Stroke Registry

Masotti¹,

Innocenti

Spolveri³

et al. 2015

Ital J Med

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Atrial fibrillation (AF) is the widest cardiac arrhythmia in general and hospital populations and it is an actual major public health problem and maybe it will be much more in the next future.1 Prevalence of AF in fact is steadily increasing, especially in the elderly. [2][3][4] Up to now, around 1% of the American general population suffers from AF, but this prevalence reaches around 10% in the octogenarians, 5 whereas in Europe the prevalence is esteemed around 5.5% of general population and 17.8% in patients over 85 years.6 This prevalence could be underestimated due to unrecognized magnitude of silent AF. The risk of stroke in AF patients is from two to seven fold greater compared with patients without AF, mean stroke rate in AF being around 5% per year. 1The annual risk of stroke is predictable by using practical scores such as CHADS 2 and the most recent CHA 2 DS 2 -VASC.1 A score ≥2 identifies high stroke risk patients, over 4% per year for the CHADS 2 and over 2.2% per year for the CHA 2 DS 2 -VASC. 1 AF related strokes are burdened by higher early and long term mortality, higher rate of complications such as hemorrhagic transformation and severe residual disability compared to the other ischemic stroke subtypes such as the atherothrombotic and lacunar forms. ©Copyright L. Masotti et al., 2015 Licensee PAGEPress, Italy Italian Journal of Medicine 2015 9:134-140 doi:10.4081/itjm.2014.450 [ ABSTRACTDespite vitamin K antagonists (VKAs) are considered the first choice treatment for stroke prevention in atrial fibrillation (AF), literature shows their underuse in this context. Since data about VKAs use prior and after acute stroke lack, the aim of this study was to focus on management of anticoagulation with VKAs in this context. Data were retrieved from Tuscan FADOI Stroke Registry, an online data bank aimed to report on characteristics of stroke patients consecutively admitted in Internal Medicine wards in 2010 and 2011. In this period 819 patients with mean age 76.5±12.3 years were enrolled. Data on etiology were available for 715 of them (88.1%), 87% being ischemic and 13% hemorrhagic strokes. AF was present in 238 patients (33%), 165 (69.3%) having a known AF before hospitalization, whereas 73 patients (31.7%) received a new diagnosis of AF. A percentage of 89% of strokes in patients with known AF were ischemic and 11% hemorrhagic. A percentage of 86.7% of patients with known AF had a CHADS 2 ≥2, but only 28.3% were on VKAs before hospitalization. A percentage of 78.8% of patients treated with VKAs before stroke had an international normalized ratio (INR) ≤2.0; 68.7% of patients with VKAs-related hemorrhagic strokes had INR ≤3.0. Combined endpoint mortality or severe disability in patients with ischemic stroke associated with AF was present in 47%, while it was present in 19.30% and 19.20% of atherothrombotic and lacunar strokes, respectively. At hospital discharge, VKAs were prescribed in 25.9% of AF related ischemic stroke patients. AF related strokes are burdened by severe outcome but VKAs are ...

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Strokes attributable to underuse of warfarin and antiplatelets

Cited by 7 publications

References 19 publications

Reduced Poststroke Mortality in Patients With Stroke and Atrial Fibrillation Treated With Anticoagulants

Reduced Poststroke Mortality in Patients With Stroke and Atrial Fibrillation Treated With Anticoagulants

Underuse of Oral Anticoagulation for Individuals with Atrial Fibrillation in a Nursing Home Setting in France: Comparisons of Resident Characteristics and Physician Attitude

Stroke prevention in atrial fibrillation: findings from Tuscan FADOI Stroke Registry

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