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

New Blood Test Predicts Major Cardiac Events Better Than Clinical Evaluation of Other Common Risk Factors
News | Blood Testing| April 28, 2017
Prevencio Inc. announced the publication of data demonstrating that a simple new blood test is more accurate than...
Feature | Inventory Management| April 28, 2017 | Dave Fornell
Tracking cardiovascular device inventory in cath labs, electrophysiology (EP) labs and operating rooms (ORs) can be a
New Twelve-Month Data Show Efficacy of Pulsar-18 Bare Metal Stent
News | Stents Peripheral| April 28, 2017
Biotronik’s Pulsar-18 bare metal stent (BMS) has yielded high primary patency in a real-world setting, according to the...
Mercator MedSystems Announces First Enrollment in TANGO Trial for Below-the-Knee Vascular Disease
News | Peripheral Arterial Disease (PAD)| April 27, 2017
Mercator MedSystems Inc. announced the first patient enrollment into the TANGO (Temsirolimus Adventitial Delivery to...
News | Venous Therapies| April 26, 2017
A new Varicose Vein Registry has begun producing useful outcomes information, as reported in the May edition of the...
Twelve-Month Data Positive for Ranger Paclitaxel-Coated Balloon Catheter
News | Drug-Eluting Balloons| April 26, 2017
Boston Scientific announced results from the RANGER SFA trial for the Ranger Paclitaxel-Coated PTA Balloon Catheter at...
Body Weight Fluctuations Linked to More Deaths in People with Coronary Artery Disease
News | Cardiac Diagnostics| April 25, 2017
Repeated cycles of weight loss and gain may be linked to higher risk for stroke, heart attack and death in people with...
AtriCure's AtriClip System Surpasses 100,000 Units Sold Worldwide
News | Left Atrial Appendage (LAA) Occluders| April 25, 2017
AtriCure Inc. announced it has sold more than 100,000 AtriClip Left Atrial Appendage Exclusion System devices worldwide...
Clinical Study Validates Efficiencies of Stereotaxis Niobe ES System Over Niobe II System
News | Robotic Systems| April 24, 2017
A recent study conducted at Centre Hospitalier Universitaire (CHU) of Saint-Étienne, France validated the advantages of...
Digital Health Company Murj Announces $4.5 Million in Financing
News | Implantable Cardiac Monitor (ICM)| April 19, 2017
Murj Inc., a digital health company that helps manage implantable cardiac device data, announced more than $4.5 million...
Overlay Init