Safely Addressing Patients with Atrial Fibrillation to Early Anticoagulation after Acute Stroke.
BACKGROUND
It has been widely reported that anticoagulants (ACs) are underused for primary and secondary prevention of ischemic stroke in patients with atrial fibrillation (AFib). Furthermore, precise evidence-based guidelines about the best timing for AC initiation after acute stroke are currently lacking.


RESULTS
In this retrospective, observational study, we analyzed prescription trends in AFib patients with acute ischemic stroke who were hospitalized in four neurologic stroke units of our region (Lombardia, Italy). In-hospital antithrombotic prescription was performed in highly heterogeneous patterns. A prestroke treatment with AC was the leading factor enhancing AC prescription during hospitalization. The other factors promoting AC were male gender, younger age, lower prestroke disability and stroke severity, and smaller stroke volumes. AFib subtype influenced AC prescription only in AC-naïve patients. Interestingly, Congestive heart failure, Hypertension, Age higher than 75 years, Diabetes, previous Stroke or TIA or thromboembolism, Vascular disease, Age 64-75 years, female Sex (CHA2DS2-VASc) and Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INRs, Elderly, Drugs and alcohol (HAS-BLED) scores were not associated with AC prescription. However, patients who were treated with AC, including early treatment (<48 hours), showed a low rate of bleeding.


CONCLUSIONS
Our findings potentially suggest that, although apparently neglecting the common risk stratification tools, our neurologists were able to select the more suitable candidates for prompt AC treatment. Further studies are needed to develop new scoring systems to aid ischemic and hemorrhagic risk estimation in the secondary prevention of stroke.
Department of Emergency Neurology and Stroke Unit, National Neurological Institute "Casimiro Mondino" IRCCS, Pavia, Italy. Electronic address: isabellacanavero@gmail.com.
Isabella
I
Canavero
Department of Emergency Neurology and Stroke Unit, National Neurological Institute "Casimiro Mondino" IRCCS, Pavia, Italy.
Anna
A
Cavallini
Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy.
Lucia
L
Sacchi
Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy.
Silvana
S
Quaglini
Department of Emergency Neurology and Stroke Unit, National Neurological Institute "Casimiro Mondino" IRCCS, Pavia, Italy.
Natale
N
Arnò
Department of Neurosciences, Neurology Unit, "Ospedale Civile", Legnano, Italy.
Patrizia
P
Perrone
Stroke Unit, Department of Neurology, "Fondazione Macchi-Ospedale di Circolo", Insubria University, Varese, Italy.
Maria Luisa
ML
DeLodovici
Emergency Neurology and Stroke Unit, "Istituto Clinico Humanitas", Milan, Italy.
Simona
S
Marcheselli
Department of Emergency Neurology and Stroke Unit, National Neurological Institute "Casimiro Mondino" IRCCS, Pavia, Italy.
Giuseppe
G
Micieli
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000150:complications; D006470:Hemorrhage / Q000209:etiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000150:complications; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D061214:Patient Safety; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy*
D000925:Anticoagulants
Acute ischemic stroke; anticoagulants; atrial fibrillation; stroke unit