title: Adherence to oral anticoagulation in secondary stroke prevention--the first year of direct oral anticoagulants.
abstract: BACKGROUND
  Patients with ischemic stroke caused by atrial fibrillation (AF) have a high risk of recurrence without adequate secondary prevention with oral anticoagulation (OAC). We investigated adherence to OAC in the first year after introduction of direct oral anticoagulants.
  
  
  METHODS
  In 284 appropriate patients, the rate of anticoagulation (AC) at discharge, adherence at 90 days and 1 year, changes between substances, and predictors for adherence to AC were analyzed. Functional outcome was assessed using the modified Rankin Scale score.
  
  
  RESULTS
  AC was initiated in 70.3% of survivors before discharge. In these patients, only 8.6% and 9.9% discontinued AC after 90 days and 1 year, respectively. In 22.1%, AC was recommended but not started before discharge. Only 53.2% of them received AC at 90 days, increasing to 67.5% at 1 year. A total of 7.6% of patients were deemed unsuitable for AC, none of them subsequently received AC. Overall, 85.4% of patients suitable for AC were treated at 1-year follow-up. No independent predictors for withholding AC were identified. Switching of medication occurred in only a minority of patients within the first year.
  
  
  CONCLUSIONS
  AC is feasible in more than 90% patients with acute ischemic stroke and AF. When initiated during the acute hospital stay, AC is discontinued in only a minority of patients. However, if AC is recommended but not started during initial hospitalization the rate of AC treatment at 90 days and 1 year is much lower. Therefore, AC should be initiated within the acute hospital stay whenever possible.
authors.affiliation: Department of Neurology, University Hospital Erlangen, Erlangen, Germany. Electronic address: Roland.Sauer@uk-erlangen.de.
authors.forename: Roland
authors.initials: R
authors.lastname: Sauer
authors.affiliation: Department of Neurology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Sauer
authors.affiliation: Department of Neurology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Bobinger
authors.affiliation: Department of Neurology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Blinzler
authors.affiliation: Department of Neurology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Hagen B
authors.initials: HB
authors.lastname: Huttner
authors.affiliation: Department of Neurology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schwab
authors.affiliation: Department of Neurology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Köhrmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011446:Prospective Studies; D055502:Secondary Prevention / Q000379:methods*; D020521:Stroke / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Atrial fibrillation; adherence; ischemic stroke; oral anticoagulation