title: Antithrombotic therapy use at discharge and 1 year in patients with atrial fibrillation and acute stroke: results from the AVAIL Registry.
abstract: OBJECTIVE
  Current American Heart Association/American Stroke Association guidelines identify warfarin use as a class IA indication in patients with atrial fibrillation (AF) and ischemic stroke (IS) or transient ischemic attack (TIA). However, few studies have examined factors associated with long-term antithrombotic therapy use in IS/TIA patients with AF.
  
  
  METHODS
  We utilized the Get With The Guidelines-Stroke national quality improvement registry and the Adherence eValuation After Ischemic Stroke Longitudinal (AVAIL) Registry to examine patterns of antithrombotic use at discharge and at 12 months in IS/TIA patients with AF. A multivariate logistic regression model was developed to identify predictors of warfarin use in this patient population at 12 months.
  
  
  RESULTS
  Of the 2460 IS/TIA patients, 291 (11.8%) had AF, of which 5.5% of patients were discharged on aspirin alone, 49.1% on warfarin alone, 1.4% on clopidogrel alone, 34.7% on warfarin plus aspirin, 2.1% on aspirin plus clopidogrel, and 1.0% on aspirin plus clopidogrel plus warfarin. Paradoxically, there was a decrease in the rate of warfarin use in patients with a CHADS2 score>3. The only factor associated with warfarin use at 12-month follow-up was male gender (adjusted odds ratio, 2.27; confidence interval, 1.22-4.35; P=0.01).
  
  
  CONCLUSIONS
  Overall, the use of warfarin therapy is high at discharge in IS/TIA patients with AF; however, there was a decrease in the rate of warfarin use in patients with a CHADS2 score>3. Compared to women, men were more likely to be on warfarin at 1 year after the index stroke event. Therefore, opportunities exist to improve antithrombotic use in all IS/TIA patients with AF.
authors: Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA. renato.lopes@duke.edu
authors: Renato D
authors: RD
authors: Lopes
authors: Bimal R
authors: BR
authors: Shah
authors: DaiWai M
authors: DM
authors: Olson
authors: Xin
authors: X
authors: Zhao
authors: Wenqin
authors: W
authors: Pan
authors: Cheryl D
authors: CD
authors: Bushnell
authors: Eric D
authors: ED
authors: Peterson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy*; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin