Influence of dementia on antithrombotic therapy prescribed before stroke in patients with atrial fibrillation.
OBJECTIVE
Oral anticoagulation (OAC) decreases the risk of stroke in patients with nonvalvular atrial fibrillation (NVAF), but remains underused in practice. The aim of this study was to test the hypothesis that prestroke dementia influenced the nonprescription of OAC before stroke.


METHODS
This is an ancillary study of Stroke in Atrial Fibrillation Ensemble II, an observational study conducted in patients with a previously known NVAF, consecutively admitted for an acute stroke to French and Italian centers. Prestroke dementia was evaluated by the clinical physician and validated by an Informant Questionnaire for Cognitive Decline in the Elderly score of >or=104 in patients with a reliable informant.


RESULTS
Of 204 patients, 24 patients met criteria for prestroke dementia according to GP's opinion. The only variables independently associated with OAC before stroke were follow-up by a cardiologist (adjusted OR: 3.33; 95% CI: 1.47-7.53) and a younger age of patients (adjusted OR: 0.94; 95% CI: 0.89-0.99). Variables independently associated with any antithrombotic drug therapy before stroke were follow-up by a general practitioner (adjusted OR: 2.78; 95% CI: 1.09-7.11), and by a cardiologist (adjusted OR: 3.15; 95% CI: 1.48-6.69).


CONCLUSIONS
In daily practice, the under-prescription of OAC in patients with NVAF mainly depends on co-morbidity and on characteristics of the physician, not on prestroke dementia.
Department of Neurology, University of Lille, Lille, and Department of Neurology, Ste Anne Hospital, Paris, France.
Catherine
C
Lefebvre
Dominique
D
Deplanque
Hilde
H
Hénon
Emmanuel
E
Touzé
Lucilla
L
Parnetti
Florence
F
Pasquier
Virgilio
V
Gallai
Didier
D
Leys
D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications / Q000523:psychology*; D015331:Cohort Studies; D003704:Dementia / Q000150:complications*; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D010818:Practice Patterns, Physicians'; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors