Document Detail

Stroke prevention in hospitalized patients with atrial fibrillation: a population-based study.
MedLine Citation:
PMID:  14712325     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Oral anticoagulants reduce the incidence of stroke by 68%, yet suboptimal use has been documented in surveys of patients with atrial fibrillation. The present study examined current patterns of anticoagulant use for patients hospitalized with atrial fibrillation across an entire health care system. METHODS: Improving Cardiovascular Outcomes in Nova Scotia (ICONS) is a prospective cohort study involving all patients hospitalized in Nova Scotia with atrial fibrillation, among other conditions. Consecutive inpatients with atrial fibrillation from October 15, 1997 to October 14, 1998 were studied. Detailed demographic and clinical data were collected and the proportion of patients using antithrombotic therapy was tabulated by risk category. Multivariate logistic regression was used to assess the relationship of various demographic and clinical factors with the use of antithrombotic agents. RESULTS: There were 2202 patients hospitalized with atrial fibrillation; 644 admitted specifically for this condition. Only 21% of patients admitted with atrial fibrillation were on warfarin sodium at admission and this increased by time of discharge. Diabetes was negatively correlated with warfarin sodium use. Histories of prosthetic valve replacement, stroke/transient ischemic attack, and heart failure were positively associated with anticoagulant use on admission. Patients with prosthetic valve replacement, heart failure, or hyperlipidemia were most likely to receive anticoagulants at discharge. CONCLUSION: Antithrombotic agents remain underused by patients with atrial fibrillation. While higher risk patients are generally targeted, this is not invariably the case; thus, diabetics remain under treated. Further work is needed to explain such anomalous practice and promote optimal antithrombotic therapy use.
Seema Nagpal; David Anderson; Wayne Putnam; Gordon Flowerdew; Martin Gardner; Jafna Cox
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Canadian journal of clinical pharmacology = Journal canadien de pharmacologie clinique     Volume:  10     ISSN:  1198-581X     ISO Abbreviation:  Can J Clin Pharmacol     Publication Date:  2003  
Date Detail:
Created Date:  2004-01-08     Completed Date:  2004-02-13     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9804162     Medline TA:  Can J Clin Pharmacol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  197-201     Citation Subset:  IM    
Epidemiology Section, Centre for Chronic Disease Prevention and Control, Ottawa, Canada.
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MeSH Terms
Anticoagulants / therapeutic use*
Aspirin / therapeutic use
Atrial Fibrillation / complications*
Drug Utilization
Fibrinolytic Agents / therapeutic use*
Prospective Studies
Stroke / etiology,  prevention & control*
Warfarin / therapeutic use
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents; 50-78-2/Aspirin; 81-81-2/Warfarin

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

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