Prevalence of oral anticoagulant therapy in clinical practice in patients hospitalized with acute ischemic stroke
https://doi.org/10.15829/1560-4071-2022-5149
Abstract
Aim. To evaluate the prevalence of oral anticoagulant therapy at the outpatient and inpatient stages in patients hospitalized with ischemic stroke.
Material and methods. This open observational prospective real-world study included 114 patients with atrial fibrillation (AF) hospitalized with confirmed stroke.
Results. Only 26,3% of patients with AF hospitalized with a confirmed diagnosis of ischemic stroke took anticoagulants (70% — direct oral anticoagulants (DOACs), 30% — warfarin). At the same time, among those taking warfarin, only one patient had normal international normalized ratio (INR) at the time of hospitalization (INR 2,6). In all other cases, the INR was <2. Of the 105 patients discharged at the outpatient stage, 93 (88,6%) patients were prescribed anticoagulants, and in most cases — DOACs (89 (84,8%)). 4 (3,8%) patients insisted on continuing warfarin therapy. There were following reasons for not prescribing DOACs: 4 (33,3%) patients were diagnosed with acute peptic ulcer during hospitalization, 2 (16,7%) — hemorrhagic transformation of the ischemic focus.
Conclusion. One of the common reasons for stroke in outpatients with AF is the refusal to take oral anticoagulants or insufficient INR control when taking warfarin.
About the Authors
E. V. Tavlueva
F.I. Inozemtsev City Clinical Hospital; National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Competing Interests:
Russian Federation
Head of the Regional Vascular Center.
Moscow
Competing Interests:
none
O. N. Savkova
F.I. Inozemtsev City Clinical Hospital
Russian Federation
Competing Interests:
Russian Federation
Head of the neurology department.
Moscow
Competing Interests:
none
E. V. Zernova
F.I. Inozemtsev City Clinical Hospital
Russian Federation
Competing Interests:
Russian Federation
Cardiologist, Department of Cardiology for patients with Acute Myocardial Infarction.
Moscow
Competing Interests:
none
S. A. Berns
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Competing Interests:
Russian Federation
Рrofessor at the Department of Therapy and General Medical Practice.
Moscow
Competing Interests:
none
O. M. Drapkina
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Competing Interests:
Russian Federation
Chief Internal Medicine and General Practice Specialist of the Ministry of Health of the Russian Federation, Academic of the of the Russian Academy of Science.
Moscow
Competing Interests:
none
References
1. Benjamin EJ, Muntner P, Alonso A, et al. American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics — 2019 update: a report from the American Heart Association. Circulation. 2019;139:e56-e528. doi:10.1161/cir.0000000000000659.
2. Staerk L, Sherer JA, Ko D. Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes. Circ Res. 2017;120:1501-17. doi:10.1161/circresaha.117.309732.
3. Rodriguez CJ, Soliman EZ, Alonso A, et al. Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors: the Multi-Ethnic Study of Atherosclerosis. Ann Epidemiol. 2015;25:71-6.e1. doi:10.1016/j.annepidem.2014.11.024.
4. Yiin GSC, Li L, Bejot Y, Rothwell PM. Time trends in atrial fibrillation-associated stroke and premorbid anticoagulation. Stroke. 2019;50:21-7. doi:10.1161/strokeaha.118.022249.
5. An Y, Ogawa H, Yamashita Y, et al. Causes of death in Japanese patients with atrial fibrillation: the Fushimi Atrial Fibrillation Registry. Eur Heart J Qual Care Clin Outcomes. 2019;5:35-42. doi:10.1093/ehjqcco/qcy033.
6. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Asso ciation of Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and mana gement of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. European Heart Journal. 2021;42(5):373-498. doi:10.1093/eurheartj/ ehaa612.
7. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med. 2007; 146:857-67. doi:10.7326/0003-4819-146-12-200706190-00007.
8. Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a metaanalysis of randomised trials. Lancet. 2014;383:955-62. doi:10.1016/s0140-6736(13) 62343-0.
9. Skirdenko YuP, Nikolaev NA. The contribution of adherence to anticoagulant therapy at the risk of complications of atrial fibrillation. Russian Journal of Cardiology. 2019;(2):64-9. (In Russ.) doi:10.15829/1560-4071-20192-64-69.
10. Аtrial fibrillation. Clinical guidelines 2020. Russian Journal of Cardiology. 2021;26(7):4594. (In Russ.) doi:10.15829/15604071-2021-4594.
11. Haas S, Camm AJ, Bassand JP, et al. Predictors of NOAC versus VKA use for stroke prevention in patients with newly diagnosed atrial fibrillation: Results from GARFIELD-AF. Am Heart J. 2019;213:35-46. doi:10.1016/j.ahj.2019.03.013.
12. Jerjes-Sanchez C, Corbalan R, Barretto ACP, et al. GARFIELD-AF Investigators. Stroke prevention in patients from Latin American countries with non-valvular atrial fibrillation: Insights from the GARFIELD-AF registry. Clin Cardiol. 2019;42(5):553-60. doi:10.1002/clc.23176.
13. Cools F, Wollaert B, Vervoort G, et al. GARFIELD-AF Investigators. Treatment patterns in anticoagulant therapy in patients with newly diagnosed atrial fibrillation in Belgium: re sults from the GARFIELD-AF registry. Acta Cardiol. 2019;74(4):309-18. doi:10.1080/00015385.2018.1494089.
14. Marcevich SYu, Navasardyan AR, Kutishenko P, Zaharova AV. Assessment of adherence to new oral anticoagulants in patients with atrial fibrillation according to the Profile register. Rational pharmacotherapy in cardiology. 2014;10(6):625-30. (In Russ.) doi:10.20996/1819-6446-201410-6-625-630.
15. Zolotovskaya IA, Davydkin IL, Duplyakov DV. Anticoagulant therapy in patients with atrial fibrillation after cardioembolic stroke: assessment of adherence to anticoagulant therapy in real clinical practice (Results of the APOLLO cohort study). Russian Journal of Cardiology. 2017;(7):105-10. (In Russ.) doi:10.15829/1560-4071-2017-7-105-110.
Supplementary files
Review
For citations:
Tavlueva E.V., Savkova O.N., Zernova E.V., Berns S.A., Drapkina O.M. Prevalence of oral anticoagulant therapy in clinical practice in patients hospitalized with acute ischemic stroke. Russian Journal of Cardiology. 2022;27(12):5149. (In Russ.) https://doi.org/10.15829/1560-4071-2022-5149
Views:
1339
Email this article 