Adherence to Guidelines for Antithrombotic Terapy in Patients with Atrial Fibrillation According to CHADS2 Score before and afer Stroke: A Multicenter Observational Study from Korea

• Published in: Journal of clinical neurology (Seoul, Korea) pp. 34 - 41
• Main Authors: 김욱주, 박종무, 강규식, 조용진, 홍근식, 이수주, 고영채, 이경복, 박태환, 이준, 차재관, 김대현, 유경호, 이병철, 오미선, 이준영, 이지성, 장명숙, 한문구, 배희준
• Format: Journal Article
• Language: English
• Published: 대한신경과학회 01.01.2016
• Subjects: 신경과학
• ISSN: 1738-6586; 2005-5013
• DOI: 10.3988/jcn.2016.12.1.34

Background and Purpose A substantial proportion of patients with atrial fbrillation (AF) are not treated optimally; however, the inappropriateness of drug therapy has never been evaluated before or afer a stroke event. We investigated the adherence to guidelines for therapy in AF patients hospitalized with acute ischemic stroke (AIS) before stroke onset and at discharge, with the aim of identifying the factors associated with inappropriate therapy. Methods AIS patients with AF hospitalized within 7 days of onset were identifed from a prospective nine-center stroke registry database. Two cohorts were defned: patients diagnosed with AF prior to the stroke event (admission cohort) and patients diagnosed with AF at discharge from hospital (discharge cohort). Any of the following conditions were regarded as nonadherence to guidelines in this study: use of anticoagulant or nonuse of antithrombotics with CHADS2 score=0, nonuse of antithrombotics with CHADS2 score=1, or nonuse of anticoagulant with CHADS2 score ≥2. Results Overall, 406 patients were enrolled in the admission cohort and 518 in the discharge cohort. Te rates of nonadherence before a stroke event and at discharge were 77.8% and 33.3%, respectively. Tese rates varied widely for both cohorts, with interhospital diferences being statistically signifcant. Multivariable analysis revealed that old age, stroke history, and congestive heart failure were associated with nonadherence before stroke. At discharge, males, coronary heart disease, inappropriate antithrombotic use before stroke, and functional disability at discharge were associated with nonadherence. Conclusions Tis study shows that antithrombotic use in AIS patients with AF might be not optimal before and afer stroke in Korea. KCI Citation Count: 9