INTRODUCTION: Information about the effect of preadmission oral anticoagulant therapy (OAT) on stroke outcome in patients with atrial fibrillation (AF) is scarce. A systematic review was done of the existing data on the association between preadmission OAT and stroke outcome in patients with AF. METHOD: We performed a systematic search in the PubMed Database, the Embase Database and the Cochrane Database of Systematic Reviews identifying 13 studies that met the inclusion criteria. RESULTS: The studies included a total of 18,523 patients with AF and admission with stroke. Of these, 1,169 had a haemorrhagic stroke. The proportion of patients in preadmission OAT varied from 5 to 37%, and the proportion who did not receive any antithrombotic therapy (AT) varied from 22 to 75%. The risk of having a severe stroke for patients with an international normalised ratio (INR) < 2 ranged from 26 to 43% compared with a 15-36% range for patients with an INR ≥ 2. The risk of death or disability among patients not receiving any AT ranged from 22 to 56% compared with 15-59% for those on platelet inhibitors, 16-48% for those on OAT with an INR < 2 and 6-37% among patients with an INR ≥ 2. These patterns were confirmed after adjustment for confounding factors. CONCLUSION: Only a minority of AF patients with stroke received OAT at the time of hospitalisation. Overall, preadmission OAT was associated with less severe strokes and a lower risk of death or disability. Further efforts seem warranted to ensure OAT for all eligible AF patients.
INTRODUCTION: Information about the effect of preadmission oral anticoagulant therapy (OAT) on stroke outcome in patients with atrial fibrillation (AF) is scarce. A systematic review was done of the existing data on the association between preadmission OAT and stroke outcome in patients with AF. METHOD: We performed a systematic search in the PubMed Database, the Embase Database and the Cochrane Database of Systematic Reviews identifying 13 studies that met the inclusion criteria. RESULTS: The studies included a total of 18,523 patients with AF and admission with stroke. Of these, 1,169 had a haemorrhagic stroke. The proportion of patients in preadmission OAT varied from 5 to 37%, and the proportion who did not receive any antithrombotic therapy (AT) varied from 22 to 75%. The risk of having a severe stroke for patients with an international normalised ratio (INR) < 2 ranged from 26 to 43% compared with a 15-36% range for patients with an INR ≥ 2. The risk of death or disability among patients not receiving any AT ranged from 22 to 56% compared with 15-59% for those on platelet inhibitors, 16-48% for those on OAT with an INR < 2 and 6-37% among patients with an INR ≥ 2. These patterns were confirmed after adjustment for confounding factors. CONCLUSION: Only a minority of AFpatients with stroke received OAT at the time of hospitalisation. Overall, preadmission OAT was associated with less severe strokes and a lower risk of death or disability. Further efforts seem warranted to ensure OAT for all eligible AFpatients.
Authors: Karl Georg Haeusler; Klaus Gröschel; Martin Köhrmann; Stefan D Anker; Johannes Brachmann; Michael Böhm; Hans-Christoph Diener; Wolfram Doehner; Matthias Endres; Christian Gerloff; Hagen B Huttner; Manfred Kaps; Paulus Kirchhof; Darius Günther Nabavi; Christian H Nolte; Waltraud Pfeilschifter; Burkert Pieske; Sven Poli; Wolf Rüdiger Schäbitz; Götz Thomalla; Roland Veltkamp; Thorsten Steiner; Ulrich Laufs; Joachim Röther; Rolf Wachter; Renate Schnabel Journal: Clin Res Cardiol Date: 2018-04-27 Impact factor: 5.460
Authors: Simon Hellwig; Ulrike Grittner; Heinrich Audebert; Matthias Endres; Karl Georg Haeusler Journal: Europace Date: 2018-04-01 Impact factor: 5.214