title: Bleeding risk, physical functioning and non-use of anticoagulation among patients with stroke and atrial fibrillation.
abstract: BACKGROUND
  Atrial fibrillation (AF) is common among people with stroke. Anticoagulation medications can be used to manage the deleterious impact of AF after stroke, however, may not be prescribed due to concerns about post-stroke falls and decreased functioning. Thus, the purpose of this study was to identify, among people with stroke and AF, predictors of anticoagulation prescription at hospital discharge.
  
  
  METHODS
  This is a secondary analysis of a retrospective cohort study of data retrieved via medical records, including National Institutes of Health Stroke Scale score, Functional Independence Measure (FIM) motor score (motor or physical function), ambulation on second day of hospitalization, Morse Falls Scale (fall risk) and HAS-BLED score (Hypertension; Abnormal renal and liver function; Stroke; Bleeding; Labile INRs; Elderly >65; and Drugs or alcohol). Data analyses included bivariate comparisons between people with and without anticoagulation at discharge. Logistic-regression modeling was used to assess predictors of discharge anticoagulation.
  
  
  RESULTS
  There were 334 subjects included in the analyses, whose average age was 75 years old. Anticoagulation was prescribed at discharge for 235 (70%) of patients. In the adjusted regression analyses, only the FIM motor score (adjusted OR = 1.015, 95% CI 1.001-1.028) and the HAS-BLED score (adjusted OR = 0.36, 95% CI 0.22-0.58) were significantly associated with anticoagulation prescription at discharge.
  
  
  CONCLUSIONS
  It appears that in this sample, post-stroke anticoagulation decisions appear to be made based on clinical factors associated with bleed risk and motor deficits or physical functioning. However, opportunities may exist for improving clinician documentation of specific reasoning for non-anticoagulation prescription.
authors.affiliation: From the Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, VA HSR&D Stroke Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, Department of Biostatistics, Indiana University, Indianapolis, IN, GRECC (182), Malcom Randall VAMC, Gainesville, FL, Department of Epidemiology, University of Florida, Gainesville, FL, Roudebush Veterans Administration (VA) Medical Center, Health Services Research and Development (HSR&D) Center for Health Information and Communication, Indianapolis, IN, Indiana University Center for Aging Research, Indianapolis, IN, Regenstrief Institute, Inc., Indianapolis, IN, Department of Neurology, Indiana University, School of Medicine and Department of Medicine, Indiana University, School of Medicine, Indianapolis, IN, USA From the Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, VA HSR&D Stroke Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, Department of Biostatistics, Indiana University, Indianapolis, IN, GRECC (182), Malcom Randall VAMC, Gainesville, FL, Department of Epidemiology, University of Florida, Gainesville, FL, Roudebush Veterans Administration (VA) Medical Center, Health Services Research and Development (HSR&D) Center for Health Information and Communication, Indianapolis, IN, Indiana University Center for Aging Research, Indianapolis, IN, Regenstrief Institute, Inc., Indianapolis, IN, Department of Neurology, Indiana University, School of Medicine and Department of Medicine, Indiana University, School of Medicine, Indianapolis, IN, USA arlene.schmid@colostate.edu.
authors.forename: A A
authors.initials: AA
authors.lastname: Schmid
authors.affiliation: From the Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, VA HSR&D Stroke Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, Department of Biostatistics, Indiana University, Indianapolis, IN, GRECC (182), Malcom Randall VAMC, Gainesville, FL, Department of Epidemiology, University of Florida, Gainesville, FL, Roudebush Veterans Administration (VA) Medical Center, Health Services Research and Development (HSR&D) Center for Health Information and Communication, Indianapolis, IN, Indiana University Center for Aging Research, Indianapolis, IN, Regenstrief Institute, Inc., Indianapolis, IN, Department of Neurology, Indiana University, School of Medicine and Department of Medicine, Indiana University, School of Medicine, Indianapolis, IN, USA.
authors.forename: S
authors.initials: S
authors.lastname: Ofner
authors.affiliation: From the Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, VA HSR&D Stroke Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, Department of Biostatistics, Indiana University, Indianapolis, IN, GRECC (182), Malcom Randall VAMC, Gainesville, FL, Department of Epidemiology, University of Florida, Gainesville, FL, Roudebush Veterans Administration (VA) Medical Center, Health Services Research and Development (HSR&D) Center for Health Information and Communication, Indianapolis, IN, Indiana University Center for Aging Research, Indianapolis, IN, Regenstrief Institute, Inc., Indianapolis, IN, Department of Neurology, Indiana University, School of Medicine and Department of Medicine, Indiana University, School of Medicine, Indianapolis, IN, USA From the Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, VA HSR&D Stroke Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, Department of Biostatistics, Indiana University, Indianapolis, IN, GRECC (182), Malcom Randall VAMC, Gainesville, FL, Department of Epidemiology, University of Florida, Gainesville, FL, Roudebush Veterans Administration (VA) Medical Center, Health Services Research and Development (HSR&D) Center for Health Information and Communication, Indianapolis, IN, Indiana University Center for Aging Research, Indianapolis, IN, Regenstrief Institute, Inc., Indianapolis, IN, Department of Neurology, Indiana University, School of Medicine and Department of Medicine, Indiana University, School of Medicine, Indianapolis, IN, USA.
authors.forename: R I
authors.initials: RI
authors.lastname: Shorr
authors.affiliation: From the Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, VA HSR&D Stroke Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, Department of Biostatistics, Indiana University, Indianapolis, IN, GRECC (182), Malcom Randall VAMC, Gainesville, FL, Department of Epidemiology, University of Florida, Gainesville, FL, Roudebush Veterans Administration (VA) Medical Center, Health Services Research and Development (HSR&D) Center for Health Information and Communication, Indianapolis, IN, Indiana University Center for Aging Research, Indianapolis, IN, Regenstrief Institute, Inc., Indianapolis, IN, Department of Neurology, Indiana University, School of Medicine and Department of Medicine, Indiana University, School of Medicine, Indianapolis, IN, USA From the Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, VA HSR&D Stroke Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, Department of Biostatistics, Indiana University, Indianapolis, IN, GRECC (182), Malcom Randall VAMC, Gainesville, FL, Department of Epidemiology, University of Florida, Gainesville, FL, Roudebush Veterans Administration (VA) Medical Center, Health Services Research and Development (HSR&D) Center for Health Information and Communication, Indianapolis, IN, Indiana University Center for Aging Research, Indianapolis, IN, Regenstrief Institute, Inc., Indianapolis, IN, Department of Neurology, Indiana University, School of Medicine and Department of Medicine, Indiana University, School of Medicine, Indianapolis, IN, USA From the Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, VA HSR&D Stroke Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, Department of Biostatistics, Indiana University, Indianapolis, IN, GRECC (182), Malcom Randall VAMC, Gainesville, FL, Depar
authors.forename: L S
authors.initials: LS
authors.lastname: Williams
authors.affiliation: From the Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, VA HSR&D Stroke Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, Department of Biostatistics, Indiana University, Indianapolis, IN, GRECC (182), Malcom Randall VAMC, Gainesville, FL, Department of Epidemiology, University of Florida, Gainesville, FL, Roudebush Veterans Administration (VA) Medical Center, Health Services Research and Development (HSR&D) Center for Health Information and Communication, Indianapolis, IN, Indiana University Center for Aging Research, Indianapolis, IN, Regenstrief Institute, Inc., Indianapolis, IN, Department of Neurology, Indiana University, School of Medicine and Department of Medicine, Indiana University, School of Medicine, Indianapolis, IN, USA From the Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, VA HSR&D Stroke Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, Department of Biostatistics, Indiana University, Indianapolis, IN, GRECC (182), Malcom Randall VAMC, Gainesville, FL, Department of Epidemiology, University of Florida, Gainesville, FL, Roudebush Veterans Administration (VA) Medical Center, Health Services Research and Development (HSR&D) Center for Health Information and Communication, Indianapolis, IN, Indiana University Center for Aging Research, Indianapolis, IN, Regenstrief Institute, Inc., Indianapolis, IN, Department of Neurology, Indiana University, School of Medicine and Department of Medicine, Indiana University, School of Medicine, Indianapolis, IN, USA From the Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, VA HSR&D Stroke Quality Enhancement Research Initiative (QUERI), Indianapolis, IN, Department of Biostatistics, Indiana University, Indianapolis, IN, GRECC (182), Malcom Randall VAMC, Gainesville, FL, Depar
authors.forename: D M
authors.initials: DM
authors.lastname: Bravata
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000503:physiopathology; D006801:Humans; D008297:Male; D063868:Patient Outcome Assessment; D011597:Psychomotor Performance / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000188:drug therapy* / Q000503:physiopathology; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin