Despite improvements in anticoagulation rates, a significant proportion of patients with atrial fibrillation admitted for stroke or TIA remain inadequately anticoagulated or have sub-therapeutic INRs.
Anticoagulation rates in AF-related stroke/TIA rose from 41% to 61.9% since 2009; confirms partial progress but leaves the treatment gap open for targeted interventions.
Introduction Atrial fibrillation (AF) increases the risk of potentially fatal or disabling ischaemic stroke, and a systematic review found <70% of eligible patients with AF are using oral anticoagulants (OACs). 1 Methods Medical records of patients admitted with stroke/TIA associated with known or new diagnosis of AF from 1 st July 2016 to 30th June 2017 were reviewed. This data was to be compared to a similar audit conducted in 2009. Data collected included age, sex, history of AF, adequacy of anticoagulation (before and after admission) and vascular risk factors. Results 49 patients (29 males, average age 76 years) were included in the study. Incidence of AF was found to be 27.9% in stroke and 8.4% among TIA admissions. Known AF occurred in 34 (82.9%) of the stroke admissions and 8 (100%) of the TIA admissions. Therefore, AF was diagnosed post-stroke in 17.1% of participants. Prior to stroke and TIA 61.9% of patients were receiving anticoagulants. Treatment prior to stroke or TIA consisted of 11 (26.2%) on DOACs, 15 (35.7%) on warfarin, 5 (11.9%) on anti-platelets, and 11 (26.2%) with no anti-thrombotics. Sub-therapeutic INRs (<2.0) upon admission were found in 60% of participants using warfarin. Among the 11 untreated patients, 1 patient was non-compliant, 1 had recent SAH, but no explanation was found for the remaining 9 participants. Anticoagulation rates improved on discharge with 40 (81.6%) patients prescribed either DOACs or warfarin. Conclusion Anticoagulation rates have improved since 2009 (61.9% vs 41%) in stroke/TIA admissions associated with AF. However, use of anticoagulants in this population remains inadequate. Furthermore, 60% of patients on warfarin had sub-therapeutic INRs upon admission. There is still a need for improved screening for AF, with only a slight decrease in rates of new diagnosis of AF compared to the 2009 audit (from 22% to 17.1%). Reference . Ogilvie IM, Newton N, Welner SA, Cowell W, Lip G. Underuse of Oral Anticoagulants in Atrial Fibrillation: A Systematic Review. The American Journal of Medicine2009;124(7):11. https://doi.org/10.1016/j.amjmed.2009.11.025
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Khan et al. (2018) studied this question.
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