Safely Addressing Patients with Atrial Fibrillation to Early Anticoagulation after Acute Stroke

Isabella Canavero, Anna Cavallini, Lucia Sacchi, Silvana Quaglini, Natale Arnò, Patrizia Perrone, Maria Luisa DeLodovici, Simona Marcheselli, Giuseppe Micieli

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND: It has been widely reported that anticoagulants (ACs) are underused for primary and secondary prevention of ischemic stroke in patients with atrial fibrillation (AFib). Furthermore, precise evidence-based guidelines about the best timing for AC initiation after acute stroke are currently lacking.

METHODS AND RESULTS: In this retrospective, observational study, we analyzed prescription trends in AFib patients with acute ischemic stroke who were hospitalized in four neurologic stroke units of our region (Lombardia, Italy). In-hospital antithrombotic prescription was performed in highly heterogeneous patterns. A prestroke treatment with AC was the leading factor enhancing AC prescription during hospitalization. The other factors promoting AC were male gender, younger age, lower prestroke disability and stroke severity, and smaller stroke volumes. AFib subtype influenced AC prescription only in AC-naïve patients. Interestingly, Congestive heart failure, Hypertension, Age higher than 75 years, Diabetes, previous Stroke or TIA or thromboembolism, Vascular disease, Age 64-75 years, female Sex (CHA2DS2-VASc) and Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INRs, Elderly, Drugs and alcohol (HAS-BLED) scores were not associated with AC prescription. However, patients who were treated with AC, including early treatment (<48 hours), showed a low rate of bleeding.

CONCLUSIONS: Our findings potentially suggest that, although apparently neglecting the common risk stratification tools, our neurologists were able to select the more suitable candidates for prompt AC treatment. Further studies are needed to develop new scoring systems to aid ischemic and hemorrhagic risk estimation in the secondary prevention of stroke.

Original languageEnglish
Pages (from-to)7-18
Number of pages12
JournalJournal of Stroke and Cerebrovascular Diseases
Volume26
Issue number1
DOIs
Publication statusPublished - Jan 2017

Fingerprint

Anticoagulants
Atrial Fibrillation
Stroke
Prescriptions
Secondary Prevention
Hemorrhage
Renal Hypertension
International Normalized Ratio
Thromboembolism
Primary Prevention
Vascular Diseases
Stroke Volume
Nervous System
Italy
Observational Studies
Hospitalization
Therapeutics
Heart Failure
Retrospective Studies
Alcohols

Keywords

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anticoagulants
  • Atrial Fibrillation
  • Drug Prescriptions
  • Female
  • Heart Failure
  • Hemorrhage
  • Hospitalization
  • Humans
  • Hypertension
  • Italy
  • Logistic Models
  • Male
  • Middle Aged
  • Neuroimaging
  • Patient Safety
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Stroke
  • Journal Article
  • Multicenter Study
  • Observational Study

Cite this

Safely Addressing Patients with Atrial Fibrillation to Early Anticoagulation after Acute Stroke. / Canavero, Isabella; Cavallini, Anna; Sacchi, Lucia; Quaglini, Silvana; Arnò, Natale; Perrone, Patrizia; DeLodovici, Maria Luisa; Marcheselli, Simona; Micieli, Giuseppe.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 26, No. 1, 01.2017, p. 7-18.

Research output: Contribution to journalArticle

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T1 - Safely Addressing Patients with Atrial Fibrillation to Early Anticoagulation after Acute Stroke

AU - Canavero, Isabella

AU - Cavallini, Anna

AU - Sacchi, Lucia

AU - Quaglini, Silvana

AU - Arnò, Natale

AU - Perrone, Patrizia

AU - DeLodovici, Maria Luisa

AU - Marcheselli, Simona

AU - Micieli, Giuseppe

N1 - Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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N2 - BACKGROUND: It has been widely reported that anticoagulants (ACs) are underused for primary and secondary prevention of ischemic stroke in patients with atrial fibrillation (AFib). Furthermore, precise evidence-based guidelines about the best timing for AC initiation after acute stroke are currently lacking.METHODS AND RESULTS: In this retrospective, observational study, we analyzed prescription trends in AFib patients with acute ischemic stroke who were hospitalized in four neurologic stroke units of our region (Lombardia, Italy). In-hospital antithrombotic prescription was performed in highly heterogeneous patterns. A prestroke treatment with AC was the leading factor enhancing AC prescription during hospitalization. The other factors promoting AC were male gender, younger age, lower prestroke disability and stroke severity, and smaller stroke volumes. AFib subtype influenced AC prescription only in AC-naïve patients. Interestingly, Congestive heart failure, Hypertension, Age higher than 75 years, Diabetes, previous Stroke or TIA or thromboembolism, Vascular disease, Age 64-75 years, female Sex (CHA2DS2-VASc) and Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INRs, Elderly, Drugs and alcohol (HAS-BLED) scores were not associated with AC prescription. However, patients who were treated with AC, including early treatment (<48 hours), showed a low rate of bleeding.CONCLUSIONS: Our findings potentially suggest that, although apparently neglecting the common risk stratification tools, our neurologists were able to select the more suitable candidates for prompt AC treatment. Further studies are needed to develop new scoring systems to aid ischemic and hemorrhagic risk estimation in the secondary prevention of stroke.

AB - BACKGROUND: It has been widely reported that anticoagulants (ACs) are underused for primary and secondary prevention of ischemic stroke in patients with atrial fibrillation (AFib). Furthermore, precise evidence-based guidelines about the best timing for AC initiation after acute stroke are currently lacking.METHODS AND RESULTS: In this retrospective, observational study, we analyzed prescription trends in AFib patients with acute ischemic stroke who were hospitalized in four neurologic stroke units of our region (Lombardia, Italy). In-hospital antithrombotic prescription was performed in highly heterogeneous patterns. A prestroke treatment with AC was the leading factor enhancing AC prescription during hospitalization. The other factors promoting AC were male gender, younger age, lower prestroke disability and stroke severity, and smaller stroke volumes. AFib subtype influenced AC prescription only in AC-naïve patients. Interestingly, Congestive heart failure, Hypertension, Age higher than 75 years, Diabetes, previous Stroke or TIA or thromboembolism, Vascular disease, Age 64-75 years, female Sex (CHA2DS2-VASc) and Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INRs, Elderly, Drugs and alcohol (HAS-BLED) scores were not associated with AC prescription. However, patients who were treated with AC, including early treatment (<48 hours), showed a low rate of bleeding.CONCLUSIONS: Our findings potentially suggest that, although apparently neglecting the common risk stratification tools, our neurologists were able to select the more suitable candidates for prompt AC treatment. Further studies are needed to develop new scoring systems to aid ischemic and hemorrhagic risk estimation in the secondary prevention of stroke.

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KW - Logistic Models

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SN - 1052-3057

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