News | Antiplatelet and Anticoagulation Therapies | March 14, 2017

Most Atrial Fibrillation Patients Don’t Get Preventive Drug Before Stroke

Duke study finds only 16 percent of afib patients had received recommended anticoagulation medication prior to having a stroke; more than two-thirds of all patients had no documented reason for not receiving proper medication

warfarin, anticoagulation therapy, atrial fibrillation patients, Duke Clinical Research Institute study, stroke

March 14, 2017 — More than 80 percent of stroke patients with a history of atrial fibrillation either received not enough or no anticoagulation therapy prior to having a stroke, according to a Duke Clinical Research Institute study. This revelation comes despite the drugs’ proven record of reducing stroke risk.

Reporting in the March 14 issue of the Journal of the American Medical Association, the researchers also found that when patients did receive recommended anticoagulation drugs, they had less severe stroke outcomes and less risk of dying.

“Atrial fibrillation is very common, and people with the condition are at a much higher risk of having stroke,” said lead author Ying Xian, M.D., Ph.D., assistant professor of neurology at Duke and member of the Duke Clinical Research Institute. “Treatment guidelines call for these patients to receive an anticoagulant such as warfarin at a therapeutic dose or a non-vitamin K antagonist oral anticoagulant (NOAC), so it’s surprising that this is not occurring in the vast majority of cases that occur in community settings.”

The study included more than 94,000 patients with atrial fibrillation from the American Heart Association’s “Get With The Guidelines-Stroke” registry who had had an acute ischemic stroke. The analysis was sponsored by the Patient-Centered Outcomes Research Institute to inform patients, physicians and others about optimal stroke care.

The researchers found that only 16 percent of patients with atrial fibrillation had received the recommended anticoagulation medication prior to having a stroke. These medications include therapeutic levels of warfarin or NOAC.

A total of 84 percent of patients were not treated according to the guidelines prior to stroke:

  • Thirty percent were not taking any antithrombotic treatment at all;
  • Forty percent were taking an antiplatelet drug such as baby aspirin or clopidogrel; and
  • Thirteen-point five percent were on warfarin, but at a level that was not considered therapeutic at the time of their stroke.

“While some of these patients may have had reasons for not being anticoagulated, such as high bleeding or fall risk, more than two-thirds had no documented reason for receiving inadequate stroke prevention therapy,” Xian said.

Xian added that in those rare cases where anticoagulation failed to prevent a stroke, patients who were taking the therapy showed a tendency to have less severe strokes, with less disability and death.

“These findings highlight the human costs of atrial fibrillation and the importance of appropriate anticoagulation,” Xian said. “Broader adherence to these atrial fibrillation treatment guidelines could substantially reduce both the number and severity of strokes in the U.S. We estimate that between 58,000 to 88,000 strokes might be preventable per year if the treatment guidelines are followed appropriately.”

In addition to Xian, study authors include Emily C. O’Brien, Li Liang, Haolin Xu, Lee H. Schwamm, Gregg C. Fonarow, Deepak L. Bhatt, Eric E. Smith, DaiWai M. Olson, Lesley Maisch, Deidre Hannah, Brianna Lindholm, Barbara L. Lytle, Michael J. Pencina, Adrian F. Hernandez, and Eric D. Peterson.

This received funding support from the Patient-Centered Outcomes Research Institute (CE-1304-7073).

Read the article "Advantages and Disadvantages of Novel Oral Anticoagulants."

Medication Adherence a Problem in Atrial Fibrillation Patients

For more information: www.www.jamanetwork.com

Related Content

Low Mortality and Stroke Risks Displayed for Minimally Invasive Aortic Valve Replacements
News | Heart Valve Technology| October 11, 2017
An analysis of more than 1,000 minimally invasive aortic valve replacements and more than 400 additional associated...
CardioFocus Announces European CE Mark Approval of HeartLight Excalibur Balloon
Technology | Ablation Systems| October 10, 2017
October 10, 2017 — CardioFocus Inc. recently announced the European CE Mark approval of the HeartLight Excalibur Ball
New Evaluation Sends Low-Risk ER Chest Pain Patients Home Sooner
News | Cardiac Diagnostics| October 10, 2017
A new evaluation to determine whether emergency room patients with chest pain can go home and follow up with their...
News | Pharmaceuticals| October 04, 2017
October 4, 2017 — MyoKardia Inc.
Medtronic Announces Post-Market Study for CoreValve Evolut Pro System
News | Heart Valve Technology| October 02, 2017
Medtronic plc recently announced a new post-market clinical study to evaluate its CoreValve Evolut Pro valve in...
The Apama Radiofrequency (RF) Balloon Catheter System.
News | Ablation Systems| October 02, 2017
October 2, 2017 — Boston Scientific announced a definitive agreement to acquire Apama Medical Inc., a privately-held
Majority of High-Risk Stroke Patients Not Being Screened for Common Risk Factors
News | Stroke| September 28, 2017
September 28, 2017 — New research revealed that on average, more than 75 percent of people aged 65 and older worldwid
Boston Scientific Launches Resonate Devices With HeartLogic Heart Failure Diagnostic
Technology | Implantable Cardioverter Defibrillator (ICD)| September 27, 2017
September 27, 2017 — Boston Scientific recently launched the Resonate family of...
Spectranetics Initiates Class I Recall for Bridge Occlusion Balloon Catheter
News | EP Lab| September 27, 2017
Spectranetics is recalling its Bridge Occlusion Balloon Catheter due to the possibility of a blocked guidewire lumen in...
BioCardia Announces 12-Month Results from TRIDENT Trial of Stem Cell Delivery System
News | Stem Cell Therapies| September 26, 2017
BioCardia Inc. recently announced 12-month results from the Phase II TRIDENT clinical trial, conducted by the...
Overlay Init