Only 42.7% of hospitalized acute ischemic stroke patients with concurrent atrial fibrillation and no contraindications were initiated on guideline-recommended oral anticoagulation at discharge.
Observational (n=16,162)
Yes
What is the prevalence of and factors associated with oral anticoagulation initiation at discharge in hospitalized patients with acute ischemic stroke and atrial fibrillation?
Less than half of eligible patients with acute ischemic stroke and atrial fibrillation are prescribed guideline-recommended oral anticoagulation at discharge, highlighting a significant gap in care.
Background This study aimed to investigate the prevalence and factors associated with the initiation of oral anticoagulation among patients with acute ischemic stroke (AIS) and concurrent atrial fibrillation (AF) at discharge in China. Methods We continuously included hospitalized patients with AIS with an AF diagnosis registered in the computer-based Online Database of Acute Stroke Patients for Stroke Management Quality Evaluation (CASE II) from January 2016 to December 2020 and divided them into a and non-anticoagulant groups according to the medications at discharge. Binary logistic regression was used to determine the factors associated with the prescription of anticoagulants in patients with AF. Results A total of 16,162 patients were enrolled. The mean age was 77 ± 9 years, 8,596 (53.2%) were males, and the median baseline National Institute of Health Stroke Scale score was 5 (2–12). Of the 14,838 patients without contraindications of antithrombotic therapy, 6,335 (42.7%) patients were initiated with anticoagulation treatment at discharge. Prior history of hemorrhagic stroke (OR 0.647, p 0.001) and gastrointestinal bleeding (OR 0.607, p = 0.003) were associated with a lower rate of anticoagulation at discharge. Patients with any intracranial hemorrhage (OR 0.268, p 0.001), gastrointestinal bleeding (OR 0.353, p 0.001), or pneumonia during hospitalization (OR 0.601, p 0.001) were less likely to receive anticoagulants at discharge. Among 7,807 patients with previously diagnosed AF and high risk of stroke (CHA 2 DS 2 -VASc ≥2), only 1,585 (20.3%) had been receiving anticoagulation treatment prior to the onset of stroke. However, the mean international normalized ratio (INR) was 1.5 on the first test during hospitalization in patients receiving warfarin. Patients complicated with a previous history of ischemic stroke/transient ischemic attack (TIA; OR 2.303, p 0.001) and peripheral artery disease (OR 1.456, p = 0.003) were more common to start anticoagulants. Conclusions Less than half of patients with AIS and concurrent AF initiated guideline-recommended oral anticoagulation at discharge, while only 20% of patients with previously diagnosed AF with a high risk of stroke had been using anticoagulants prior to the onset of stroke, which highlights a large care gap in hospitalized stroke patients and the importance of AF management.
Gong et al. (Wed,) conducted a observational in Acute ischemic stroke with concurrent atrial fibrillation (n=16,162). Oral anticoagulation vs. No oral anticoagulation was evaluated on Initiation of oral anticoagulation treatment at discharge among patients without contraindications. Only 42.7% of hospitalized acute ischemic stroke patients with concurrent atrial fibrillation and no contraindications were initiated on guideline-recommended oral anticoagulation at discharge.
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