Antithrombotic treatment before stroke onset and stroke severity in patients with atrial fi brillation andfi rst-ever ischemic stroke: An observational study
- Author:
Helen L Po
;
Ya-Ju Lin
- Publication Type:Journal Article
- From:Neurology Asia
2010;15(1):11-17
- CountryMalaysia
- Language:English
-
Abstract:
Background and Objectives: Atrial fi brillation (AF) is an important, independent risk factor for stroke.
The value of antithrombotic therapy to prevent stroke is well established in numerous randomized
controlled trials. The objectives of this study were to determine the rate and the factors associated
with the prescription of antithrombotic treatment before fi rst-ever ischemic stroke in patients with
known AF; and to assess the association between preadmission antithrombotic therapy and stroke
severity, death or disability. Methods: Consecutive patients with acute fi rst-ever ischemic stroke and
AF admitted to Mackay Memorial Hospital from July 2005 to June 2007 were included in the study.
We reviewed the use of antithrombotic agents before stroke onset, the international normalized ratio
at admission and coexisting illness. The severity of stroke was graded using the National Institute of
Health Stroke Scale. Disability was measured at discharge and during 90 days follow-up according to
modifi ed-Rankin Scale. Results: A total of 1,952 patients were admitted with ischemic stroke during the
study period. Of these, 152 patients with AF experienced fi rst-ever ischemic stroke. Of 152 patients,
124 (82%) were known to have AF and 28 (18%) were diagnosed with AF during admission. Before
stroke, 69 out of 124 patients with known AF (56%) were not on antithrombotic therapy, 30 (24%)
were receiving antithrombotic treatment but inadequately treated, and 25 (20%) were adequately
treated according to the current guidelines. Younger age (<75 years), history of ischemic heart disease,
diabetes mellitus and congestive heart failure were associated with the use of antithrombotic therapy
before stroke onset. At discharge and during 90 days follow-up, 28% of the adequately treated patients
died or were severely disabled compared with 57% of those inadequately treated.
Conclusion: Antithrombotic treatment was underutilized before stroke onset, and this underuse is
associated with increased mortality or disability in ischemic stroke patients with AF.
- Full text:P020150824460495193573.pdf
