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Antithrombotic therapy for ischaemic stroke patients with AF/RHD in West China daily practice
Insights
Anticoagulation use in ischemic stroke patients with atrial fibrillation/rheumatic heart disease is low in West China. Warfarin and antiplatelets significantly reduced death risk, highlighting a need for improved implementation.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Current guidelines strongly recommend anticoagulation for ischemic stroke (IS) patients with atrial fibrillation (AF) and/or rheumatic heart disease (RHD).
- However, the underuse of anticoagulation in this patient population is a global concern.
- Limited data exists on the implementation of antithrombotic therapy for AF/RHD patients in West China.
Purpose of the Study:
- To investigate the patterns and adherence of antithrombotic treatment in IS patients with AF and/or RHD.
- To compare the effectiveness of antithrombotic therapy in reducing mortality.
- To assess the real-world utilization of warfarin in this patient group in West China.
Main Methods:
- A consecutive series of acute IS patients diagnosed with AF and/or RHD were recruited.
- Data on antithrombotic therapy use before and after admission were collected.
- Patient outcomes, including mortality, were followed for 1 year post-stroke onset.
Main Results:
- 155 patients were analyzed; 113 had AF and/or RHD.
- Only 43.4% were on antithrombotics pre-admission, with 8.0% on warfarin.
- At 1 year, 81.3% were on antithrombotics, 34.3% on warfarin alone; warfarin persistence was 77.8%.
- Antiplatelets and warfarin significantly reduced 1-year mortality risk compared to no antithrombotic therapy (P=0.005).
Conclusions:
- Real-world warfarin use in IS patients with AF/RHD remains low in West China.
- Significant benefits of antithrombotic therapy in reducing mortality were observed.
- Implementation studies are needed to improve antithrombotic prescribing practices in this region.
Background And Objective:
Although, current evidence-based guidelines advocate anticoagulation as a strong recommendation in IS patients with AF/RHD, the underuse of anticoagulation in IS patients with AF/RHD has been found in clinical practice worldwide. Nevertheless, there was little information about implementation of antithrombotic therapy to prevent stroke for patients with AF and/or RHD in daily practice in West China. Our study determined to clarify the patterns, adherence and comparative effect of antithrombotic treatment during 1-year follow-up in IS patients with AF and/or RHD.
Method:
Consecutive patients with acute IS and AF/RHD admitted to Department of Neurology, West China Hospital from November 2010 to October 2011 were included in the study.
Results:
155 consecutive patients were analysed in this study. One hundred thirteen patients have been diagnosed as AF and/or RHD before admission. Of these, 49 (43.4%) patients were receiving antithrombotic therapy before the time of admission, including nine (8.0%) patients receiving warfarin. At 12 months after stroke onset, 109 (81.3%) patients were on antithrombotics, and 46 (34.3%) patients were on warfarin alone. The persistence rate of warfarin use at 1 year was 77.8%. Moreover, there were 80 (81.6%) patients never starting to use warfarin. Compared with no antithrombotic therapy, anti-platelets and warfarin reduced death risk significantly during 1-year after stroke onset (P = 0.005).
Conclusion:
Our study suggests that overall real-world use of warfarin in IS patients with AF and/or RHD is low before and after admission in West China. Implementation study on this respect should be conducted in this area to improve the daily practice.