Anticoagulation Therapy in Patients With Atrial Fibrillation

HealthDay News — Many patients with atrial fibrillation who experience a stroke may not have been on appropriate anticoagulation therapy, according to a study published in the Journal of the American Medical Association.

The latest findings are based on records from 94,474 US patients with ischemic stroke and a history of atrial fibrillation. The team led by Ying Xian, MD, PhD, an assistant professor of neurology at the Duke University School of Medicine in Durham, NC, found that some of the patients were at heightened risk of internal bleeding or falling. But for two-thirds, Xian told HealthDay, there was no documented reason they should avoid the medications. All of the patients were diagnosed with a stroke at some point between 2012 and 2015.

Overall, Xian’s team found, 83.6% had not been getting adequate anticoagulation before their stroke. That was despite the fact that almost all of the patients would have been considered high-risk for a stroke. Some patients were not on an anticoagulant at all, while others were on a subtherapeutic warfarin dose or antiplatelet therapy only.

“Among patients with atrial fibrillation who had experienced an acute ischemic stroke, inadequate therapeutic anticoagulation preceding the stroke was prevalent,” the authors write. “Therapeutic anticoagulation was associated with lower odds of moderate or severe stroke and lower odds of in-hospital mortality.”

Several authors disclosed financial ties to the pharmaceutical industry.

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Xian Y, O’Brien EC, Liang L, et al. Association of preceding antithrombotic treatment with acute ischemic stroke severity and in-hospital outcomes among patients with atrial fibrillation. JAMA. 2017;317(10):1057-1067. doi: 10.1001/jama.2017.1371