title: Preadmission oral anticoagulant treatment and clinical outcome among patients hospitalized with acute stroke and atrial fibrillation: a nationwide study.
abstract: OBJECTIVE
  Preadmission oral anticoagulant treatment (OAT) has been linked with less severe stroke and a better outcome in patients with atrial fibrillation. However, the existing studies have methodological limitations and have, with one exception, not included hemorrhagic strokes. We performed a nationwide historic follow-up study using data from population-based healthcare registries to assess the effect of preadmission OAT on stroke outcomes further.
  
  
  METHODS
  We identified 11 356 patients with atrial fibrillation admitted to hospital with acute stroke (including ischemic stroke and intracerebral hemorrhage) between 2003 and 2009. Propensity score-matched analyses were used to compare stroke severity (Scandinavian Stroke Scale score) and mortality among 2175 patients with preadmission OAT and 2175 patients without preadmission OAT.
  
  
  RESULTS
  A total of 2492 (21.9%) patients received OAT at the time of their stroke. Preadmission OAT was associated with a lower risk of severe stroke (Scandinavian Stroke Scale score at time of admission, <30 point; propensity score-matched odds ratio, 0.74; 95% confidence interval, 0.63-0.86) and lower 30-day mortality rate (propensity score-matched adjusted odds ratio, 0.83; 95% confidence interval, 0.71-0.98).
  
  
  CONCLUSIONS
  Only a minority of hospitalized patients with acute stroke with atrial fibrillation received OAT at the time of stroke. Preadmission OAT was associated with less severe stroke and lower 30-day mortality rate in a propensity score-matched analysis.
authors.affiliation: From the Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark (S.P.J., M.L.S., F.M.); Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark (M.L.H.); Department of Cardiology, Odense University Hospital, Odense, Denmark (A.B.); and Department of Medicine, Regional Hospital West Jutland, Jutland, Denmark (S.E.H.).
authors.forename: Søren Paaske
authors.initials: SP
authors.lastname: Johnsen
authors.forename: Marie Louise
authors.initials: ML
authors.lastname: Svendsen
authors.forename: Morten Lock
authors.initials: ML
authors.lastname: Hansen
authors.forename: Axel
authors.initials: A
authors.lastname: Brandes
authors.forename: Frank
authors.initials: F
authors.lastname: Mehnert
authors.forename: Steen Elkjær
authors.initials: SE
authors.lastname: Husted
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy*; D003718:Denmark / Q000453:epidemiology; D004522:Educational Status; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010644:Phenprocoumon / Q000627:therapeutic use; D011153:Population; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D010644:Phenprocoumon
keywords: atrial fibrillation; stroke