BACKGROUND AND PURPOSE: Current American Heart Association/American Stroke Association guidelines identify warfarin use as a class IA indication in patients with atrial fibrillation (AF) and ischemic stroke (IS) or transient ischemic attack (TIA). However, few studies have examined factors associated with long-term antithrombotic therapy use in IS/TIA patients with AF. METHODS: We utilized the Get With The Guidelines-Stroke national quality improvement registry and the Adherence eValuation After Ischemic Stroke Longitudinal (AVAIL) Registry to examine patterns of antithrombotic use at discharge and at 12 months in IS/TIA patients with AF. A multivariate logistic regression model was developed to identify predictors of warfarin use in this patient population at 12 months. RESULTS: Of the 2460 IS/TIA patients, 291 (11.8%) had AF, of which 5.5% of patients were discharged on aspirin alone, 49.1% on warfarin alone, 1.4% on clopidogrel alone, 34.7% on warfarin plus aspirin, 2.1% on aspirin plus clopidogrel, and 1.0% on aspirin plus clopidogrel plus warfarin. Paradoxically, there was a decrease in the rate of warfarin use in patients with a CHADS2 score>3. The only factor associated with warfarin use at 12-month follow-up was male gender (adjusted odds ratio, 2.27; confidence interval, 1.22-4.35; P=0.01). CONCLUSIONS: Overall, the use of warfarin therapy is high at discharge in IS/TIA patients with AF; however, there was a decrease in the rate of warfarin use in patients with a CHADS2 score>3. Compared to women, men were more likely to be on warfarin at 1 year after the index stroke event. Therefore, opportunities exist to improve antithrombotic use in all IS/TIA patients with AF.
BACKGROUND AND PURPOSE: Current American Heart Association/American Stroke Association guidelines identify warfarin use as a class IA indication in patients with atrial fibrillation (AF) and ischemic stroke (IS) or transient ischemic attack (TIA). However, few studies have examined factors associated with long-term antithrombotic therapy use in IS/TIApatients with AF. METHODS: We utilized the Get With The Guidelines-Stroke national quality improvement registry and the Adherence eValuation After Ischemic Stroke Longitudinal (AVAIL) Registry to examine patterns of antithrombotic use at discharge and at 12 months in IS/TIApatients with AF. A multivariate logistic regression model was developed to identify predictors of warfarin use in this patient population at 12 months. RESULTS: Of the 2460 IS/TIApatients, 291 (11.8%) had AF, of which 5.5% of patients were discharged on aspirin alone, 49.1% on warfarin alone, 1.4% on clopidogrel alone, 34.7% on warfarin plus aspirin, 2.1% on aspirin plus clopidogrel, and 1.0% on aspirin plus clopidogrel plus warfarin. Paradoxically, there was a decrease in the rate of warfarin use in patients with a CHADS2 score>3. The only factor associated with warfarin use at 12-month follow-up was male gender (adjusted odds ratio, 2.27; confidence interval, 1.22-4.35; P=0.01). CONCLUSIONS: Overall, the use of warfarin therapy is high at discharge in IS/TIApatients with AF; however, there was a decrease in the rate of warfarin use in patients with a CHADS2 score>3. Compared to women, men were more likely to be on warfarin at 1 year after the index stroke event. Therefore, opportunities exist to improve antithrombotic use in all IS/TIApatients with AF.
Authors: Margaret C Fang; Alan S Go; Yuchiao Chang; Leila H Borowsky; Niela K Pomernacki; Natalia Udaltsova; Daniel E Singer Journal: Neurology Date: 2014-02-14 Impact factor: 9.910
Authors: Anna L Parks; Sun Y Jeon; W John Boscardin; Michael A Steinman; Alexander K Smith; Margaret C Fang; Sachin J Shah Journal: J Am Geriatr Soc Date: 2021-03-05 Impact factor: 7.538
Authors: A John Camm; Gabriele Accetta; Giuseppe Ambrosio; Dan Atar; Jean-Pierre Bassand; Eivind Berge; Frank Cools; David A Fitzmaurice; Samuel Z Goldhaber; Shinya Goto; Sylvia Haas; Gloria Kayani; Yukihiro Koretsune; Lorenzo G Mantovani; Frank Misselwitz; Seil Oh; Alexander G G Turpie; Freek W A Verheugt; Ajay K Kakkar Journal: Heart Date: 2016-09-19 Impact factor: 5.994
Authors: Gregory Y H Lip; Sana M Al-Khatib; Francisco G Cosio; Amitava Banerjee; Irina Savelieva; Jeremy Ruskin; Dan Blendea; Stanley Nattel; Joseph De Bono; Jennifer M Conroy; Paul L Hess; Eduard Guasch; Jonathan L Halperin; Paulus Kirchhof; M Dolores G Cosio; A John Camm Journal: J Am Heart Assoc Date: 2014-08-27 Impact factor: 5.501