title: Impact of atrial fibrillation and inadequate antithrombotic management on mortality in acute neurovascular syndrome.
abstract: BACKGROUND
  The purpose of this study was to observe adherence to antithrombotic management guidelines among atrial fibrillation (AF) patients and to determine prognostic factors for 3-month mortality in both ischemic and hemorrhagic stroke patients with or without AF.
  
  
  METHODS
  This was a retrospective observational single stroke center cohort study. In 2007, 380 patients with acute stroke-like symptoms were admitted to Tampere University Hospital as candidates for intravenous thrombolysis. Group comparisons (with or without AF) were performed, and binary logistic regression modeling was used to predict 3-month mortality for different clinical and imaging variables.
  
  
  RESULTS
  The prevalence of AF in the acute neurovascular syndrome population was 33%. During hospitalization, the detection rate of previously undiagnosed paroxysmal AF was 8% (17 of 217). Only 26% (18 of 69) of known AF-related ischemic stroke patients had an International Normalized Ratio value above 1.9. National Institutes of Health Stroke Scale score and Alberta Stroke Program Early Computed Tomography Score at admission in ischemic stroke and intracerebral hemorrhage were significant prognostic factors for 3-month mortality in acute neurovascular syndrome patients with AF according to a multivariable analysis. Inadequate antithrombotic management according to at-the-time and current treatment guidelines was not a risk factor for 3-month mortality.
  
  
  CONCLUSIONS
  Patients with AF have more severe stroke and higher mortality than stroke patients without AF. Adherence to the antithrombotic treatment guidelines for the prevention of AF-related cardioembolic strokes is suboptimal. Further studies are needed to evaluate the impact of current antithrombotic treatment guidelines on mortality.
authors.affiliation: School of Medicine, University of Tampere, Tampere, Finland. Electronic address: jukka.saarinen@uta.fi.
authors.forename: Jukka T
authors.initials: JT
authors.lastname: Saarinen
authors.affiliation: Department of Neurology, Oulu University Hospital, Oulu, Finland.
authors.forename: Harri
authors.initials: H
authors.lastname: Rusanen
authors.affiliation: Medical Imaging Centre, Tampere University Hospital, Tampere, Finland.
authors.forename: Niko
authors.initials: N
authors.lastname: Sillanpää
authors.affiliation: School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.affiliation: Department of Neurology, Tampere University Hospital, Tampere, Finland.
authors.forename: Heikki
authors.initials: H
authors.lastname: Numminen
authors.affiliation: School of Medicine, University of Tampere, Tampere, Finland.
authors.forename: Irina
authors.initials: I
authors.lastname: Elovaara
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000401:mortality; D002545:Brain Ischemia / Q000150:complications / Q000401:mortality; D015331:Cohort Studies; D000075202:Contraindications; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D019983:Guideline Adherence; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000401:mortality; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents
keywords: Intravenous thrombolytic therapy; atrial fibrillation; oral anticoagulation—computed tomography (CT)