Underuse of Anti-Clotting Therapies Common among Patients with Atrial Fibrillation who Have a Stroke

Inadequate use of anticoagulation therapies was prevalent among patients with atrial fibrillation who experienced a stroke, according to a study appearing in the March 14 issue of JAMA.

Atrial fibrillation (AF) is an independent risk factor for stroke, increases stroke risk by a factor of 4 to 5, and accounts for 10 percent to 15 percent of all ischemic strokes. While the burden of AF-related stroke is high, AF is a potentially treatable risk factor. Numerous studies have demonstrated that vitamin K antagonists, such as warfarin, or non-vitamin K antagonist oral anticoagulants (NOACs), reduce the risk of ischemic stroke. Based on these data, current guidelines recommend adjusted-dose warfarin or NOACs over aspirin for stroke prevention in high-risk patients with AF.

Ying Xian, M.D., Ph.D., of the Duke University Medical Center, Durham, N.C., and colleagues conducted a study that included 94,474 patients who had an acute ischemic stroke and known history of AF admitted to hospitals participating in the Get With the Guidelines-Stroke program.

Of these patients:

• 84 percent were not receiving therapeutic anticoagulation prior to stroke


• 30 percent were not receiving any antithrombotic treatment prior to stroke


• 7.6 percent were receiving therapeutic warfarin


• 8.8 percent were receiving NOACs


• 40 percent were receiving antiplatelet therapy only

Therapeutic anticoagulation was associated with lower odds of moderate or severe stroke and lower odds of in-hospital mortality.

“Atrial fibrillation is a highly prevalent and important, but treatable, risk factor for stroke. Despite numerous international guideline recommendations, many patients fail to receive proper treatment for stroke prevention,” the authors write.