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Antithrombotic therapy use at discharge and 1 year in patients with atrial fibrillation and acute stroke: results from the AVAIL Registry.

Publication ,  Journal Article
Lopes, RD; Shah, BR; Olson, DM; Zhao, X; Pan, W; Bushnell, CD; Peterson, ED
Published in: Stroke
December 2011

BACKGROUND AND PURPOSE: Current American Heart Association/American Stroke Association guidelines identify warfarin use as a class IA indication in patients with atrial fibrillation (AF) and ischemic stroke (IS) or transient ischemic attack (TIA). However, few studies have examined factors associated with long-term antithrombotic therapy use in IS/TIA patients with AF. METHODS: We utilized the Get With The Guidelines-Stroke national quality improvement registry and the Adherence eValuation After Ischemic Stroke Longitudinal (AVAIL) Registry to examine patterns of antithrombotic use at discharge and at 12 months in IS/TIA patients with AF. A multivariate logistic regression model was developed to identify predictors of warfarin use in this patient population at 12 months. RESULTS: Of the 2460 IS/TIA patients, 291 (11.8%) had AF, of which 5.5% of patients were discharged on aspirin alone, 49.1% on warfarin alone, 1.4% on clopidogrel alone, 34.7% on warfarin plus aspirin, 2.1% on aspirin plus clopidogrel, and 1.0% on aspirin plus clopidogrel plus warfarin. Paradoxically, there was a decrease in the rate of warfarin use in patients with a CHADS2 score>3. The only factor associated with warfarin use at 12-month follow-up was male gender (adjusted odds ratio, 2.27; confidence interval, 1.22-4.35; P=0.01). CONCLUSIONS: Overall, the use of warfarin therapy is high at discharge in IS/TIA patients with AF; however, there was a decrease in the rate of warfarin use in patients with a CHADS2 score>3. Compared to women, men were more likely to be on warfarin at 1 year after the index stroke event. Therefore, opportunities exist to improve antithrombotic use in all IS/TIA patients with AF.

Duke Scholars

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

December 2011

Volume

42

Issue

12

Start / End Page

3477 / 3483

Location

United States

Related Subject Headings

  • Warfarin
  • Ticlopidine
  • Stroke
  • Risk Factors
  • Registries
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Lopes, R. D., Shah, B. R., Olson, D. M., Zhao, X., Pan, W., Bushnell, C. D., & Peterson, E. D. (2011). Antithrombotic therapy use at discharge and 1 year in patients with atrial fibrillation and acute stroke: results from the AVAIL Registry. Stroke, 42(12), 3477–3483. https://doi.org/10.1161/STROKEAHA.111.625392
Lopes, Renato D., Bimal R. Shah, DaiWai M. Olson, Xin Zhao, Wenqin Pan, Cheryl D. Bushnell, and Eric D. Peterson. “Antithrombotic therapy use at discharge and 1 year in patients with atrial fibrillation and acute stroke: results from the AVAIL Registry.Stroke 42, no. 12 (December 2011): 3477–83. https://doi.org/10.1161/STROKEAHA.111.625392.
Lopes RD, Shah BR, Olson DM, Zhao X, Pan W, Bushnell CD, et al. Antithrombotic therapy use at discharge and 1 year in patients with atrial fibrillation and acute stroke: results from the AVAIL Registry. Stroke. 2011 Dec;42(12):3477–83.
Lopes, Renato D., et al. “Antithrombotic therapy use at discharge and 1 year in patients with atrial fibrillation and acute stroke: results from the AVAIL Registry.Stroke, vol. 42, no. 12, Dec. 2011, pp. 3477–83. Pubmed, doi:10.1161/STROKEAHA.111.625392.
Lopes RD, Shah BR, Olson DM, Zhao X, Pan W, Bushnell CD, Peterson ED. Antithrombotic therapy use at discharge and 1 year in patients with atrial fibrillation and acute stroke: results from the AVAIL Registry. Stroke. 2011 Dec;42(12):3477–3483.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

December 2011

Volume

42

Issue

12

Start / End Page

3477 / 3483

Location

United States

Related Subject Headings

  • Warfarin
  • Ticlopidine
  • Stroke
  • Risk Factors
  • Registries
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies