Associations with anticoagulation: a cross-sectional registry-based analysis of stroke survivors with atrial fibrillation.
OBJECTIVE
To describe vitamin K antagonist (VKA) anticoagulation prescribing patterns in stroke survivors with atrial fibrillation (AF), with particular emphasis on sociodemographic associations with VKA prescription.


METHODS
We conducted a cross-sectional analysis of city-wide Glasgow primary care data held as part of the Local Enhanced Services (LES) for the year 2010. We collated clinical and sociodemographic data of community-dwelling ischaemic stroke survivors with AF, including risk factors; comorbidity; socioeconomic status and prescribing. We described stroke risk and bleeding risk using recommended stratification tools (CHA2DS2-VASC and HAS-BLED). Univariate and multivariate associations with anticoagulant prescription were described by ORs and corresponding 95% CI.


RESULTS
We identified 3429 community-dwelling, ischaemic stroke survivors with AF; median age 78 (IQR 72-84); 1699 (49%) male. Median CHA2DS2-VASC score was 5 (IQR 4-6). VKA was prescribed in 1165 (34%). On univariate analysis, higher CHA2DS2-VASC was associated with fewer VKA prescriptions (OR 0.90, 95% CI 0.45 to 0.95). On multivariate analysis, older age (OR 0.97, 95% CI 0.96 to 0.98) and higher deprivation scores (OR 0.59, 95% CI 0.57 to 0.76) were independently associated with non-prescription of VKA.


CONCLUSIONS
Anticoagulation was underused in this high-risk population, and those at highest risk were less likely to be treated. Strategies need to be developed to improve prescription of anticoagulation treatment.
Institute of Cardiovascular and Medical Sciences, University of Glasgow, , Glasgow, UK.
Azmil H
AH
Abdul-Rahim
Jao
J
Wong
Christine
C
McAlpine
Camilla
C
Young
Terence J
TJ
Quinn
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D012042:Registries; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control*; D017741:Survivors
D000925:Anticoagulants