Why the study?
A previous study at the institution identified that warfarin was under-utilised in patients with atrial fibrillation, prompting a replication to assess changes 10 years later.
Has the proportion of appropriately anticoagulated patients with ischaemic stroke and atrial fibrillation improved over a decade?
Has the proportion of appropriately anticoagulated patients with ischaemic stroke and atrial fibrillation improved over a decade?
Appropriate anticoagulation in patients with ischemic stroke and atrial fibrillation has significantly improved over a decade, largely driven by DOAC use, though unexplained sub-therapeutic dosing remains an issue in 10% of cases.
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Anticoagulation rates in AF-stroke have risen over time; supports temporal improvement but leaves open drivers and outcome impact.
A study at our institution conducted 10 years ago identified that warfarin was under-utilised in patients with atrial fibrillation. We replicated this study and compared the results. There was a significant increase in the proportion of patients appropriately anticoagulated (63% vs 9%, P < 0.001). Eighty-seven percent of eligible patients were appropriately anticoagulated on discharge (86% previously). Seventy-two percent of treated patients were prescribed a direct oral anticoagulant. Of these, 10% were discharged with a sub-therapeutic dose without obvious explanation.
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Sharobeam et al. (2020) studied this question.
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