Physicians' Academy for Cardiovascular Education

Large majority of AF patients who suffered from stroke were not adequately anticoagulated

Association of Preceding Antithrombotic Treatment With Acute Ischemic Stroke Severity and In-Hospital Outcomes Among Patients With Atrial Fibrillation

Literature - Xian Y, O’Brien EC, Liang L et al., - JAMA. 2017;317(10):1057-1067. doi:10.1001/jama.2017.1371


Although the burden of atrial fibrillation (AF)-associated stroke risk is high, AF is a treatable risk factor for stroke. It is well documented that anticoagulants such as vitamin K antagonists (VKA) and non-VKA oral anticoagulants (NOACs) reduce stroke risk in AF patients. Current guidelines therefore recommend adjusted-dose warfarin (a VKA) or NOACs for stroke prevention in high-risk patients with AF.

Oral anticoagulants are often underused in community practice [1,2]. Little is known about the prevalence of preceding antithrombotic treatment among AF patients who develop acute ischemic stroke and whether this therapy affects stroke severity and outcomes.

This study therefore examined preceding antithrombotic therapy in patients with AF who have experienced an acute ischemic stroke, and the association between treatment and initial stroke severity, in-hospital mortality and functional outcomes at discharge. This analysis was part of the Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) study [2-6]. PROSPER builds on the American Heart Association (AHA)/American Stroke Association (ASA) Get With the Guidelines–Stroke (GWTG-Stroke) Registry program. This retrospective analysis included data of patients (n=94474, admitted to 1622 hospitals, mean age : 79.9 years, SD: 11.0) with a known history of AF or atrial flutter who experienced an acute ischemic stroke and were admitted from October 2012 through March 2015. The NIHSS score was used as a measure of stroke severity (range of 0-42, with a higher score indicating greater stroke severity).

Main results


In this nationwide, contemporary registry of patients with a known history of AF who had experienced an acute ischemic stroke, 84% did not receive guideline-recommended anticoagulation or had subtherapeutic anticoagulation levels. This affects clinical outcomes, as preceding coagulation with NOACs or therapeutic warfarin was associated with less severe stroke and fewer deaths during the hospital stay.


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