Related Experiment Video
Updated: Sep 4, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Deceptive Adherence to Anticoagulation in Secondary Stroke Prevention
Riina Vibo1, Juhan-Mats Kuningas1, Prinno Tsakuhhin1
1Department of Neurology and Neurosurgery, University of Tartu, Estonia L. Puusepa 8, 50406 Tartu, Estonia.
Insights
Oral anticoagulant (OAC) adherence after stroke is modest. First-ever stroke was the sole predictor of good adherence, highlighting the need for improved secondary stroke prevention strategies.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Atrial fibrillation (AF) patients require oral anticoagulants (OACs) to prevent ischemic stroke.
- Assessing OAC treatment adherence is crucial for secondary stroke prevention.
Purpose of the Study:
- To evaluate OAC treatment adherence in patients post-ischemic stroke with AF.
- To identify predictors of OAC adherence using patient data.
Main Methods:
- Retrospective cohort study of ischemic stroke and AF patients (2017-2018).
- Data sourced from hospital records, electronic prescriptions, and health records.
- Logistic regression analysis to identify adherence predictors.
Main Results:
- 202 of 237 (85%) patients used OACs; mean adherence was 81% with only 68% showing good adherence.
- First-ever stroke was the only significant predictor of good treatment adherence.
- Complications occurred in 23% of OAC patients; good adherence was noted in 70% with hemorrhagic and 52% with thromboembolic complications.
Conclusions:
- OAC treatment adherence post-stroke is modest.
- First-ever stroke is the sole identified predictor of good or full OAC adherence.
- Further research is needed to enhance OAC adherence for effective secondary stroke prevention.
Background:
Oral anticoagulants (OAC) effectively reduce the risk for ischemic stroke in patients with atrial fibrillation (AF). We aimed to assess OAC treatment adherence in secondary stroke prevention and to find predictors of adherence using individualized patient data.
Methods:
This retrospective cohort study included patients with a discharge diagnosis of ischemic stroke and AF from Tartu University Hospital from 2017 to 2018. Data from patient charts and the Electronic Hospital Information, Estonian Electronic Prescription, and Estonian Electronic Health Record systems were registered.
Results:
Of the 353 patients, 237 (67%) were prescribed OAC treatment at discharge and during the first year after stroke, 202 (85%) of them used OAC treatment. The mean adherence was 81%, while only 68% had good adherence. Reduced non-vitamin K antagonist OAC (NOAC) dose was used in 68 patients (39%), which was justified in 23 (34%). First-ever stroke occurrence was the only significant factor for good treatment adherence in logistic regression analysis. There were 47 patients (23%) with complications among the patients on OAC treatment. Majority of the patients (70%) with hemorrhagic complications and 52% of patients with thromboembolic complications had good treatment adherence.
Conclusions:
Our study showed that OAC treatment adherence following stroke was modest and first-ever stroke was the only predictor of good or full treatment adherence.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:30Venous Thrombosis IV: Nursing Management
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care