Adherence and quality of oral anticoagulation in cerebrovascular disease patients with atrial fibrillation.
OBJECTIVE
Low rates and poor quality of oral anticoagulation (OAC) have been reported in patients with atrial fibrillation (AF). We therefore sought to investigate the prescription patterns at discharge, adherence and quality of OAC in cerebrovascular disease patients with AF.


METHODS
Consecutive ischemic stroke (IS) and transient ischemic attack (TIA) patients were prospectively documented in 11 German stroke centers. A central telephone follow-up after 1-2 years assessed the current antithrombotic medication and results of coagulation checks.


RESULTS
Of 1,463 surviving patients with AF, 30.5% were discharged on OAC and 13.9% on high-dose heparin. Of 329 AF patients discharged on OAC and with consent for follow-up, 88.7% of surviving patients were still on OAC at the follow-up. Of these, 52.7% reported coagulation values out of the therapeutic range during the preceding 3 months. A recurrent IS was seen in 9 patients (2.1%/year) and an intracranial hemorrhage in 2.


CONCLUSIONS
We found an important underuse of OAC following TIA or IS mainly in older patients and with greater stroke-related disability. Although the reported coagulation checks showed an only moderate rate within therapeutic ranges, safety and efficacy of OAC in this cohort seem comparable to previous randomized and observational trials in AF patients.
Weimar
C
C
Department of Neurology, University of Duisburg-Essen, Essen, Germany. stroke.med@uni-essen.de
Benemann
J
J
Katsarava
Z
Z
Weber
R
R
Diener
H-C
HC
D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000209:etiology; D001780:Blood Coagulation Tests / Q000706:statistics & numerical data; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'
D000925:Anticoagulants