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| Anticoagulation often cannot be started in stroke patients with atrial fibrillation |
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10 May 2006
About half of patients with atrial fibrillation (AF)-related stroke are not started on anticoagulation therapy before leaving the hospital, new research suggests. Common reasons cited by clinicians for not starting such therapy were severe disability, high risk of falls, and limited life expectancy.
The researchers note that stroke patients in AF have a 10-20% risk of recurrent stroke. "The decision to start or continue anticoagulation requires clinical judgment and should be made on a case by case basis after a complete risk benefit assessment," Dr Alan Barber and colleagues, from Auckland City Hospital in New Zealand, emphasise.
The findings, which appear in the May issue of Stroke, are based on a study of all patients with ischaemic stroke seen at the authors' institution over a 12-month period. Of the 412 patients identified, 93 had AF and were the focus of the current analysis.
Sixty-four of the patients were known to have AF before the stroke occurred, but only 13 of them had been given warfarin. Seventeen of the patients (18%) with AF-related stroke died before hospital discharge, 48 (52%) were sent home, and 28 (30%) were discharged to institutional care. Warfarin therapy was recommended for 35 of the 76 (46%) stroke survivors. For the remaining 41 patients (54%), the decision was made not to prescribe warfarin. Dependent status and discharge to institutional care were strong predictors of not starting warfarin therapy (p<0.001 for both). The most common reason for not starting warfarin therapy, cited in 13 patients, was severe disability and frailty. The next most common reasons were high risk of falls and limited life expectancy, cited in 12 and 4 patients, respectively.
"In this cohort of all AF-associated ischaemic stroke patients presenting to our institution, the underutilisation of anticoagulation primarily occurred before stroke onset," the authors note. "That only half of the survivors in this study could be started on warfarin reflects the poor prognosis from AF-associated ischaemic stroke."
Reference:
Stroke 2006; 37 (5): 1217-1220.
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