Oral Anticoagulant Therapy Use in Older Stroke Surivors

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Almost half of the patients were not prescribed an oral anticoagulant despite a median CHA<sub>2</sub>DS<sub>2</sub>VASc score of 5.
Almost half of the patients were not prescribed an oral anticoagulant despite a median CHA2DS2VASc score of 5.

HealthDay News – Many patients surviving ischemic stroke are not discharged with an oral anticoagulant (OAC), according to a study published online in the Journal of the American Geriatrics Society.

Emer R. McGrath, PhD, from Massachusetts General Hospital in Boston, and colleagues conducted a retrospective cohort study involving 1405 individuals (mean age: 79 years) with ischemic stroke surviving hospitalization. Reasons for nonuse of OAC were identified using structured chart review; survival was assessed one year after stroke.

The researchers found that 44% of participants were not prescribed an OAC at discharge even though the median CHA2DS2VASc score was 5. Fall risk, poor prognosis, bleeding history, participant or family refusal, older age, and dementia were the most frequent (non-mutually exclusive) physician reasons for not prescribing OAC. The most important independent predictors of nonuse of OACs were older age and disability. By one year, 42.5% and 19.1% of those not receiving an OAC and receiving an OAC at discharge had died, respectively (P <.001).

"To improve anticoagulation decisions and outcomes in this population, future research should focus on strategies to mitigate fall risk, improve assessment of risks and benefits of anticoagulation in individuals with atrial fibrillation, and determine whether newer anticoagulants are safer in complex elderly and frail individuals," the authors wrote.

Disclosures: Several authors disclosed financial ties to the pharmaceutical and health care industries.

Reference

McGrath ER, Go AS, Chang Y, et al. Use of oral anticoagulant therapy in older adults with atrial fibrillation after acute ischemic stroke [Published online December 30, 2016]. J Am Geriatr Soc. doi:10.1111/jgs.14688

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