Key result
Only ~68% of post-stroke patients maintain good adherence to oral anticoagulation.
Why the study?
Oral anticoagulants effectively reduce ischemic stroke risk in AF, but adherence patterns and predictors in secondary stroke prevention required evaluation.
What is the adherence rate to oral anticoagulants in patients with atrial fibrillation following an ischemic stroke?
Cohort (n=353)
No
What is the adherence rate to oral anticoagulants in patients with atrial fibrillation following an ischemic stroke?
Adherence to oral anticoagulation in stroke survivors with AF is suboptimal, with inappropriate dose reductions being common and first-ever stroke being the only significant predictor of good adherence.
Suboptimal OAC adherence after stroke in AF patients warrants monitoring; leaves open targeted interventions for recurrent stroke cases.
Background: Oral anticoagulants (OAC) effectively reduce the risk for ischemic stroke in patients with atrial fibrillation (AF). We aimed to assess OAC treatment adherence in secondary stroke prevention and to find predictors of adherence using individualized patient data. Methods: This retrospective cohort study included patients with a discharge diagnosis of ischemic stroke and AF from Tartu University Hospital from 2017 to 2018. Data from patient charts and the Electronic Hospital Information, Estonian Electronic Prescription, and Estonian Electronic Health Record systems were registered. Results: Of the 353 patients, 237 (67%) were prescribed OAC treatment at discharge and during the first year after stroke, 202 (85%) of them used OAC treatment. The mean adherence was 81%, while only 68% had good adherence. Reduced non-vitamin K antagonist OAC (NOAC) dose was used in 68 patients (39%), which was justified in 23 (34%). First-ever stroke occurrence was the only significant factor for good treatment adherence in logistic regression analysis. There were 47 patients (23%) with complications among the patients on OAC treatment. Majority of the patients (70%) with hemorrhagic complications and 52% of patients with thromboembolic complications had good treatment adherence. Conclusions: Our study showed that OAC treatment adherence following stroke was modest and first-ever stroke was the only predictor of good or full treatment adherence.
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Vibo et al. (2022) conducted a cohort in Atrial fibrillation and ischemic stroke (n=353). Oral anticoagulants (OAC) was evaluated on Good or full treatment adherence (medication possession ratio ≥80%). Mean OAC treatment adherence following stroke was 81%, with only 68% of patients achieving good or full adherence (MPR ≥80%), and first-ever stroke was the sole predictor of good adherence.
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