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August 11, 2015European Journal of Neurology

Underuse of anticoagulation in stroke patients with atrial fibrillation – the FibStroke Study

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Key result

Only 55.1% of high-risk atrial fibrillation patients were on oral anticoagulation before a stroke or TIA, commonly withheld due to infrequent AF, previous bleeds, or patient preference.

Why the study?

What are the reasons for underuse of oral anticoagulation in high-risk patients with atrial fibrillation who suffer a stroke or TIA?

Population

3404 patients with previously diagnosed atrial fibrillation who suffered a total of 2955 ischaemic strokes…

Comparison

Oral anticoagulation (OAC) vs No oral anticoagulation

Design

Cohort

Authors

APAntti PalomäkiGeneral / Preventive / LipidsPMPirjo MustonenElectrophysiologyJHJuha HartikainenElectrophysiology

Discussion

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Overview

OAC underuse persists before stroke in high-risk AF; leaves open effective strategies to address common withholding reasons.

Study Design

Type

Observational (n=3,404)

Structured PICO

What are the reasons for underuse of oral anticoagulation in high-risk patients with atrial fibrillation who suffer a stroke or TIA?

P
Population
3,404 patients with previously diagnosed atrial fibrillation who suffered an ischemic stroke or TIA between 2003 and 2012.
E
Exposure
Oral anticoagulation (OAC)
C
Comparator
No oral anticoagulation
O
Outcome
Proportion of high-risk patients on OAC before stroke/TIA and reasons for withholding OAC

Underuse of oral anticoagulation is a common contributor to ischemic strokes and TIAs in patients with atrial fibrillation, often due to infrequent AF episodes, previous bleeds, and patient preference.

Cite This Study

Palomäki et al. (2015) conducted an observational in Atrial fibrillation with stroke or TIA (n=3,404). Oral anticoagulation (OAC) vs. No OAC was evaluated on Proportion of high-risk patients (CHADS2 ≥2) on OAC before the onset of stroke or TIA. Only 55.1% of high-risk atrial fibrillation patients were on oral anticoagulation before a stroke or TIA, commonly withheld due to infrequent AF, previous bleeds, or patient preference.

synapsesocial.com/papers/6a70731d2fdcb5703edb5df4https://doi.org/10.1111/ene.12820
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Use of Oral Anticoagulation Therapy in Atrial Fibrillation after Stroke: Results from a Nationwide Registry2013 · 15 citations
  2. 2Use of oral anticoagulants in atrial fibrillation is highly variable and only weakly associated with estimated stroke risk: Cross-sectional population database study2013 · 12 citations
  3. 3Use of Oral Anticoagulant Therapy in Older Adults with Atrial Fibrillation After Acute Ischemic Stroke2016 · 55 citations
  4. 4Risks and Benefits of Anticoagulation in Atrial Fibrillation2013 · 85 citations
  5. 5Decision-Making in Clinical Practice: Oral Anticoagulant Therapy in Patients with Non-valvular Atrial Fibrillation and a Single Additional Stroke Risk Factor2016 · 15 citations