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Most Atrial Fibrillation Patients Don’t Get Preventive Drug Before Stroke

Most Atrial Fibrillation Patients Don’t Get Preventive Drug Before Stroke
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Duke University Medical Center


Duke University Medical Center (click to view)

Duke University Medical Center

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Anticoagulants were not used according to guidelines, despite evidence they prevent strokes.

More than 80 percent of stroke patients with a history of atrial fibrillation either received not enough or no anticoagulation therapy prior to having a stroke, despite the drugs’ proven record of reducing stroke risk, according to a Duke Clinical Research Institute study.

Reporting in the March 14 issue of the Journal of the American Medical Association, the researchers also found that when patients did receive recommended anticoagulation drugs, they had less severe stroke outcomes and less risk of dying.

“Atrial fibrillation is very common, and people with the condition are at a much higher risk of having stroke,” said lead author Ying Xian, M.D., Ph.D., assistant professor of neurology at Duke and member of the Duke Clinical Research Institute. “Treatment guidelines call for these patients to receive an anticoagulant such as warfarin at a therapeutic dose or a non-vitamin K antagonist oral anticoagulant (NOAC), so it’s surprising that this is not occurring in the vast majority of cases that occur in community settings.”

The study included more than 94,000 patients with atrial fibrillation from the American Heart Association’s “Get With The Guidelines-Stroke” registry who had had an acute ischemic stroke. The analysis was sponsored by the Patient-Centered Outcomes Research Institute to inform patients, physicians and others about optimal stroke care.


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The researchers found that only 16 percent of patients with atrial fibrillation had received the recommended anticoagulation medication prior to having a stroke. These medications include therapeutic levels of warfarin or NOAC.

A total of 84 percent of patients were not treated according to the guidelines prior to stroke:

  • 30% were not taking any antithrombotic treatment at all;
  • 40% were taking an antiplatelet drug such as baby aspirin or clopidogrel;
  • 13.5% were on warfarin, but at a level that was not considered therapeutic at the time of their stroke.

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