Background:
Despite high efficacy in clinical trials for stroke prevention, oral anticoagulant (OAC) therapy in patients with atrial fibrillation (AF) remains vastly underutilized in real world practice. Earlier studies have suggested that important subgroups (elderly, women, blacks) may be especially prone to under treatment. Our objective was to examine the patterns of antithrombotic medication use following an AF-related stroke within a Stroke Clinical Network. The Stroke Clinical Network consists of nine stroke centers located in rural, suburban and urban geographical regions.
Methods:
The GWTG registry was queried (calendar years 2014-2018) to identify ischemic stroke patients discharged with AF and age, gender, race and discharge antithrombotic medications. We evaluated patterns of medication use across the entire network and also among women, elderly patients (>80 years), and blacks vs. whites. Fisher’s exact test was used to assess statistical differences between subgroups.
Results:
Among 7,483 IS patients 1,406 had a diagnosis of AF: 70% were White, 25% Black; mean age of 76.9 years (SD +/-12.25 years) with 50% women. In the entire group, the rate of OAC use at discharge was 62%, with no difference based upon sex (p=0.55). Among patients receiving OAC treatment, women had a higher rate of direct oral anticoagulant (DOAC) prescription (53% vs. 48%, p=0.049). There were differences in antithrombotic practices based on age (< 80, mean age 70 years, >80 mean age 86.9 years). In patients <80 years, 68% received OAC therapy, compared to 52% in the elderly group (p<0.0001). Black patients were younger than white patients (70 years vs. 79.3 years) and more likely to receive OAC treatment (71% vs. 60%, p=0.0003).
Conclusions:
In a geographically diverse Stroke Network, we identified that OAC treatment is underutilized following an AF-related stroke, especially in elderly patients. This analysis will provide the Stroke Clinical Network an opportunity to develop interventions to target patient subgroups with low OAC treatment rates. With the aging of the US population, innovative methods are needed to improve the rate of OAC use in elderly patients with AF.
Traumatic events involving elderly patients treated with anticoagulants for atrial fibrillation: the downside of stroke prevention
