Document Detail

Potentially preventable strokes in high-risk patients with atrial fibrillation who are not adequately anticoagulated.
MedLine Citation:
PMID:  18757287     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Warfarin is the most effective stroke prevention medication for high-risk individuals with atrial fibrillation, yet it is often underused. This study examined the magnitude of this problem in a large contemporary, prospective stroke registry. METHODS: We analyzed data from the Registry of the Canadian Stroke Network, a prospective database of consecutive patients with stroke admitted to 12 designated stroke centers in Ontario (2003 to 2007). We included patients admitted with an acute ischemic stroke who (1) had a known history of atrial fibrillation; (2) were classified as high risk for systemic emboli according to published guidelines; and (3) had no known contraindications to anticoagulation. Primary end points were the use of prestroke antithrombotic medications and admission international normalized ratio. RESULTS: Among patients admitted with a first ischemic stroke who had known atrial fibrillation (n=597), strokes were disabling in 60% and fatal in 20%. Preadmission medications were warfarin (40%), antiplatelet therapy (30%), and no antithrombotics (29%). Of those taking warfarin, three fourths had a subtherapeutic international normalized ratio (<2.0) at the time of stroke admission. Overall, only 10% of patients with acute stroke with known atrial fibrillation were therapeutically anticoagulated (international normalized ratio >/=2.0) at admission. In stroke patients with a history of atrial fibrillation and a previous transient ischemic attack or ischemic stroke (n=323), only 18% were taking warfarin with therapeutic international normalized ratio at the time of admission for stroke, 39% were taking warfarin with subtherapeutic international normalized ratio, and 15% were on no antithrombotic therapy. CONCLUSIONS: In high-risk patients with atrial fibrillation admitted with a stroke, and who were candidates for anticoagulation, most were either not taking warfarin or were subtherapeutic at the time of ischemic stroke. Many were on no antithrombotic therapy. These findings should encourage greater efforts to prescribe and monitor appropriate antithrombotic therapy to prevent stroke in individuals with atrial fibrillation.
David J Gladstone; Esther Bui; Jiming Fang; Andreas Laupacis; M Patrice Lindsay; Jack V Tu; Frank L Silver; Moira K Kapral
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-08-28
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  40     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-30     Completed Date:  2009-02-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  235-40     Citation Subset:  IM    
FRCPC, Director, Regional Stroke Prevention Clinic, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room A442, Toronto, Ontario, Canada.
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MeSH Terms
Aged, 80 and over
Anticoagulants / administration & dosage*
Atrial Fibrillation / epidemiology*
Brain Ischemia / drug therapy,  mortality,  prevention & control
Cohort Studies
Dose-Response Relationship, Drug
Endpoint Determination
International Normalized Ratio
Monitoring, Physiologic / standards
Patient Admission / statistics & numerical data
Prospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Stroke / drug therapy,  mortality*,  prevention & control*
Treatment Outcome
Warfarin / administration & dosage*
Reg. No./Substance:
0/Anticoagulants; 81-81-2/Warfarin
Comment In:
Stroke. 2009 Jan;40(1):5-7   [PMID:  18757283 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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