Key Points
- To assess preadmission vitamin K antagonist use in patients with known atrial fibrillation and evaluate how pre-stroke antithrombotic therapy impacts functional disability and long-term survival.
- Consecutive cohort analysis of 2,390 stroke patients admitted to Charité Berlin, Germany between 2003 and 2004, with a mean follow-up of 38 months (range 0–68).
- Univariable and multivariable regression models evaluated determinants of preadmission anticoagulation, stroke severity, and long-term mortality.
- Among 325 patients with pre-existing atrial fibrillation eligible for therapy, 75 (23.1%) received vitamin K antagonists, and only 20 (6.2%) maintained an international normalized ratio of 2–3 at stroke onset.
- Therapeutic anticoagulation independently predicted lower stroke severity (OR 0.28, 95% CI 0.09–0.84), along with age (OR 1.02 per year, 95% CI 1.00–1.04) and coronary artery disease (OR 1.51, 95% CI 1.01–2.26).
- Predictors of long-term mortality included age (HR 3.11 to 11.1 across categories from 65 to ≥85 years), admission stroke severity (HR 1.60 for NIHSS 6–15; HR 3.23 for NIHSS >15), and preadmission antiplatelet therapy (HR 1.85, 95% CI 1.21–2.82), whereas therapeutic anticoagulation did not significantly affect long-term survival.
Structured PICO
Does preadmission therapeutic anticoagulation with vitamin K antagonists reduce stroke severity and improve long-term survival in stroke patients with atrial fibrillation?
PPopulation2390 consecutive stroke patients (including 534 with atrial fibrillation, of which 348 had AF known before the index stroke) admitted to a single center in Germany.
IInterventionPreadmission therapeutic anticoagulation with vitamin K antagonists.
CComparatorNo preadmission therapeutic anticoagulation.
OOutcomeStroke severity on admission and long-term survival after stroke.hard clinical
In patients with atrial fibrillation, therapeutic anticoagulation prior to stroke onset significantly reduces stroke severity but does not significantly impact long-term survival, highlighting the importance of guideline-directed anticoagulation.