Related Experiment Video
Updated: Jul 16, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Choice of Oral Anticoagulant: Outcomes in Atrial Fibrillation Patients Post-Stroke Despite Direct Oral Anticoagulant
Eric Duong1, Mu Lin2, Mathew Hodgson1
1Pharmacy Services, Alberta Health Services, Edmonton, Alberta, Canada.
Insights
For patients with atrial fibrillation experiencing stroke or TIA despite direct oral anticoagulants (DOACs), continuing the same DOAC regimen did not increase stroke/TIA or bleeding risks. Medication adherence improved post-event, indicating an optimization opportunity.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Optimal anticoagulation strategy remains unclear for atrial fibrillation patients experiencing ischemic stroke or TIA while on direct oral anticoagulants (DOACs).
- Understanding post-event anticoagulant management is crucial for preventing recurrent events and bleeding.
Purpose of the Study:
- To compare anticoagulant use patterns after a stroke or TIA in atrial fibrillation patients on DOACs.
- To assess the impact of different anticoagulant strategies on stroke/TIA recurrence and bleeding events.
- To evaluate changes in medication adherence following a stroke or TIA.
Main Methods:
- Retrospective analysis of provincial administrative databases in Alberta, Canada.
- Comparison of anticoagulant use (same DOAC, different dose, switched DOAC, switched to warfarin, no anticoagulant) before and after index stroke/TIA.
- Assessment of stroke/TIA recurrence and bleeding events, considering medication adherence (Proportion of Days Covered ≥ 80%).
Main Results:
- Among 985 patients, 63% continued the same DOAC regimen post-event.
- Rates of recurrent stroke/TIA (14%) and bleeding (5%) did not differ significantly across different anticoagulant prescribing patterns.
- Medication adherence improved significantly post-stroke/TIA, with the proportion of patients achieving ≥ 80% PDC increasing from 55% to 80%.
Conclusions:
- Maintaining the same DOAC regimen after stroke/TIA in atrial fibrillation patients is a common and safe strategy regarding recurrent events and bleeding.
- Stroke/TIA severity may influence prescribing decisions.
- Improved DOAC adherence post-event presents an opportunity for optimizing patient management.
Background:
For patients with atrial fibrillation who have an ischemic stroke or transient ischemic attack (TIA) despite taking direct oral anticoagulants (DOACs), the optimal strategy for ongoing anticoagulation is unknown.
Methods:
Using provincial administrative databases in Alberta, Canada, we compared anticoagulant use before/after the breakthrough stroke/TIA and assessed recurrence of stroke/TIA or bleeding, with consideration of medication adherence. Adherence was defined as the proportion of days covered (PDC) being ≥ 80%.
Results:
Among 985 patients, the median age was 80 years (interquartile range 13), with a mean CHADS2 score of 1.7± 1 prior to the index event. Patients were followed for a median of 643 days (interquartile range 836). Following the index stroke/TIA event, 623 patients (63%) filled a prescription for the same DOAC regimen, 83 (8%) filled a prescription for a different dose, 155 (16%) switched DOAC agents, 51 (5%) switched to warfarin, and 73 (7%) filled no oral anticoagulant prescription. Patients who kept the same regimen more commonly had TIA index events (59%); patients who changed dose or drug more often had stroke index events (55%-78%). During follow-up, 135 (14%) had stroke/TIA recurrence, and 46 (5%) had bleeding; rates of each did not differ between prescribing patterns. Post-index event, the proportion of patients with a proportion of days covered ≥ 80% improved from 55% to 80%.
Conclusions:
Although most maintained the same DOAC regimen after stroke/TIA, rates of recurrent stroke/TIA and bleeding were similar across prescribing patterns. Stroke/TIA severity may have influenced prescribing practices. DOAC prescription adherence improved poststroke/TIA and signals an opportunity for optimization in patients with atrial fibrillation.
Related Concept Videos
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...
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:29Venous Thrombosis III: Interprofessional Care
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
01:30Venous Thrombosis IV: Nursing Management