A Palomäki1, P Mustonen2, J E K Hartikainen3, I Nuotio4, T Kiviniemi1, A Ylitalo5, P Hartikainen6, K E J Airaksinen1. 1. Heart Center, Turku University Hospital and University of Turku, Turku, Finland. 2. Department of Medicine, Keski-Suomi Central Hospital, Jyväskylä, Finland. 3. Heart Center, Kuopio University Hospital, Kuopio, Finland. 4. Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland. 5. Heart Center, Satakunta Central Hospital, Pori, Finland. 6. Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland.
Abstract
BACKGROUND AND PURPOSE: Current guidelines recommend oral anticoagulation (OAC) for patients with atrial fibrillation (AF) and increased risk of thromboembolic events. The reasons for not using OAC in AF patients suffering stroke or transient ischaemic attack (TIA) were assessed. METHODS: This retrospective registry included 3404 patients with previously diagnosed AF who suffered a total of 2955 ischaemic strokes and 895 TIAs during 2003-2012. RESULTS: A CHA2DS2-VASc score ≥2 and a CHADS2 score ≥2 was observed in 3590 (93.2%) and in 2784 (72.3%) of the events, respectively. Of the high-risk patients (CHADS2 ≥2) only 55.1% were on OAC before the onset of stroke or TIA. The most frequently documented reasons for withholding OAC were infrequent paroxysms of AF (14%), previous bleeding episodes (13%) and the patient's decline/independent discontinuation of treatment (9%). Moreover, patients with paroxysmal AF (40% using OAC), previous bleeding (26% using OAC) and alcohol abuse (30% using OAC) were using OAC significantly less often than patients without these characteristics. A significant increase in the proportion of high-risk patients using OAC from 49% in 2003 to 65% in 2012 was seen. CONCLUSIONS: Underuse of anticoagulation is a common contributor to ischaemic strokes and TIA episodes in patients with AF. Infrequent AF episodes, previous bleeds, patient preference and alcohol abuse were the most common reasons for not using OAC.
BACKGROUND AND PURPOSE: Current guidelines recommend oral anticoagulation (OAC) for patients with atrial fibrillation (AF) and increased risk of thromboembolic events. The reasons for not using OAC in AFpatients suffering stroke or transient ischaemic attack (TIA) were assessed. METHODS: This retrospective registry included 3404 patients with previously diagnosed AF who suffered a total of 2955 ischaemic strokes and 895 TIAs during 2003-2012. RESULTS: A CHA2DS2-VASc score ≥2 and a CHADS2 score ≥2 was observed in 3590 (93.2%) and in 2784 (72.3%) of the events, respectively. Of the high-risk patients (CHADS2 ≥2) only 55.1% were on OAC before the onset of stroke or TIA. The most frequently documented reasons for withholding OAC were infrequent paroxysms of AF (14%), previous bleeding episodes (13%) and the patient's decline/independent discontinuation of treatment (9%). Moreover, patients with paroxysmal AF (40% using OAC), previous bleeding (26% using OAC) and alcohol abuse (30% using OAC) were using OAC significantly less often than patients without these characteristics. A significant increase in the proportion of high-risk patients using OAC from 49% in 2003 to 65% in 2012 was seen. CONCLUSIONS: Underuse of anticoagulation is a common contributor to ischaemic strokes and TIA episodes in patients with AF. Infrequent AF episodes, previous bleeds, patient preference and alcohol abuse were the most common reasons for not using OAC.
Authors: Antti Palomäki; Tuomas Kiviniemi; Juha E K Hartikainen; Pirjo Mustonen; Antti Ylitalo; Ilpo Nuotio; Päivi Hartikainen; Jussi Jaakkola; Riho Luite; K E Juhani Airaksinen Journal: Clin Cardiol Date: 2016-05-30 Impact factor: 2.882
Authors: Nicolae Done; Amanda M Roy; Yingzhe Yuan; Steven D Pizer; Adam J Rose; Julia C Prentice Journal: Health Serv Res Date: 2018-11-11 Impact factor: 3.402
Authors: Heidi Lehtola; Juha Hartikainen; Päivi Hartikainen; Tuomas Kiviniemi; Ilpo Nuotio; Antti Palomäki; Antti Ylitalo; K E Juhani Airaksinen; Pirjo Mustonen Journal: Clin Cardiol Date: 2018-05-10 Impact factor: 2.882
Authors: Jussi Jaakkola; Pirjo Mustonen; Tuomas Kiviniemi; Juha E K Hartikainen; Antti Palomäki; Päivi Hartikainen; Ilpo Nuotio; Antti Ylitalo; K E Juhani Airaksinen Journal: PLoS One Date: 2016-12-09 Impact factor: 3.240
Authors: Oliver Königsbrügge; Alexander Simon; Hans Domanovits; Ingrid Pabinger; Cihan Ay Journal: BMC Cardiovasc Disord Date: 2016-12-09 Impact factor: 2.298
Authors: David R Vinson; E Margaret Warton; Dustin G Mark; Dustin W Ballard; Mary E Reed; Uli K Chettipally; Nimmie Singh; Sean Z Bouvet; Bory Kea; Patricia C Ramos; David S Glaser; Alan S Go Journal: West J Emerg Med Date: 2018-02-12
Authors: Jussi Jaakkola; Päivi Hartikainen; Tuomas O Kiviniemi; Ilpo Nuotio; Antti Palomäki; Juha E K Hartikainen; Antti Ylitalo; Pirjo Mustonen; K E Juhani Airaksinen Journal: Neurol Clin Pract Date: 2019-08