title: Preadmission oral anticoagulant therapy and clinical outcome in patients hospitalised with acute stroke and atrial fibrillation.
abstract: BACKGROUND
  Information about the effect of preadmission oral anticoagulant therapy (OAT) on stroke outcome in patients with atrial fibrillation (AF) is scarce. A systematic review was done of the existing data on the association between preadmission OAT and stroke outcome in patients with AF.
  
  
  METHODS
  We performed a systematic search in the PubMed Database, the Embase Database and the Cochrane Database of Systematic Reviews identifying 13 studies that met the inclusion criteria.
  
  
  RESULTS
  The studies included a total of 18,523 patients with AF and admission with stroke. Of these, 1,169 had a haemorrhagic stroke. The proportion of patients in preadmission OAT varied from 5 to 37%, and the proportion who did not receive any antithrombotic therapy (AT) varied from 22 to 75%. The risk of having a severe stroke for patients with an international normalised ratio (INR) < 2 ranged from 26 to 43% compared with a 15-36% range for patients with an INR ≥ 2. The risk of death or disability among patients not receiving any AT ranged from 22 to 56% compared with 15-59% for those on platelet inhibitors, 16-48% for those on OAT with an INR < 2 and 6-37% among patients with an INR ≥ 2. These patterns were confirmed after adjustment for confounding factors.
  
  
  CONCLUSIONS
  Only a minority of AF patients with stroke received OAT at the time of hospitalisation. Overall, preadmission OAT was associated with less severe strokes and a lower risk of death or disability. Further efforts seem warranted to ensure OAT for all eligible AF patients.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark. tobiasottosen@gmail.com.
authors.forename: Tobias Pilgaard
authors.initials: TP
authors.lastname: Ottosen
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: Grethe
authors.initials: G
authors.lastname: Andersen
authors.forename: Steen Elkjær
authors.initials: SE
authors.lastname: Husted
authors.forename: Søren Paaske
authors.initials: SP
authors.lastname: Johnsen
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D004334:Drug Administration Schedule; D006760:Hospitalization; D006801:Humans; D019934:International Normalized Ratio; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants