title: Shifting Perceptions of Risk and Reward: Use of Anticoagulation in Patients With Acute Brain Ischemia and Atrial Fibrillation: Nine-Year Data From a National Acute Stroke Registry (National Acute Stroke Israeli Survey [NASIS]).
abstract: Despite overwhelming evidence for the benefits of anticoagulation in patients with brain ischemia and atrial fibrillation, vast underuse has been reported.
  
  
  
  Use of anticoagulation for secondary stroke prevention was assessed in the National Acute Stroke Israeli Survey registry (NASIS) of hospitalized patients with atrial fibrillation and acute brain ischemia. Logistic regression analysis was performed to evaluate the effects of clinical covariates on anticoagulation therapy at discharge, and anticoagulation use over time was assessed in subgroups of patients with identified barriers to anticoagulation utilization.
  
  
  
  There were 1254 survivors of acute brain ischemia with atrial fibrillation (mean age 77.2±10.6 years; 57.7% female). Between 2004 and 2013, the proportion of patients discharged on anticoagulation increased from 55% to 76.2%, and among those without perceived contraindications from 70% to 96% (P<0.0001). Older age, greater stroke severity, earlier registry period, and presence of contraindications were independent predictors of withholding therapy. Increased anticoagulation use over the years was observed even in patients with barriers to anticoagulation use, including patients with potential contraindications (P<0.001).
  
  
  
  In survivors of acute brain ischemia with atrial fibrillation, we observed a substantial increase in anticoagulation utilization within less than a decade. This change was mainly driven by greater utilization of anticoagulation in subgroups with traditional clinical barriers to anticoagulation use, indicating a shift in physicians' perceptions of the risk-benefit ratio of anticoagulation.
authors.affiliation: From the Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., D.T.); Department of Neurology, Elias Sourasky Medical Center, Tel Aviv, Israel (N.M.B.); Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel (G.I.); Israeli Association for Cardiovascular Trials, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel (M.E., D.G.); and Sackler Faculty of Medicine, Tel Aviv University, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., N.M.B., G.I., E.S., D.T.). yvonne.schwammenthal@sheba.health.gov.il.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Schwammenthal
authors.affiliation: From the Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., D.T.); Department of Neurology, Elias Sourasky Medical Center, Tel Aviv, Israel (N.M.B.); Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel (G.I.); Israeli Association for Cardiovascular Trials, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel (M.E., D.G.); and Sackler Faculty of Medicine, Tel Aviv University, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., N.M.B., G.I., E.S., D.T.).
authors.forename: Rakefet
authors.initials: R
authors.lastname: Tsabari
authors.affiliation: From the Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., D.T.); Department of Neurology, Elias Sourasky Medical Center, Tel Aviv, Israel (N.M.B.); Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel (G.I.); Israeli Association for Cardiovascular Trials, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel (M.E., D.G.); and Sackler Faculty of Medicine, Tel Aviv University, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., N.M.B., G.I., E.S., D.T.).
authors.forename: David
authors.initials: D
authors.lastname: Orion
authors.affiliation: From the Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., D.T.); Department of Neurology, Elias Sourasky Medical Center, Tel Aviv, Israel (N.M.B.); Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel (G.I.); Israeli Association for Cardiovascular Trials, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel (M.E., D.G.); and Sackler Faculty of Medicine, Tel Aviv University, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., N.M.B., G.I., E.S., D.T.).
authors.forename: Oleg
authors.initials: O
authors.lastname: Merzlyak
authors.affiliation: From the Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., D.T.); Department of Neurology, Elias Sourasky Medical Center, Tel Aviv, Israel (N.M.B.); Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel (G.I.); Israeli Association for Cardiovascular Trials, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel (M.E., D.G.); and Sackler Faculty of Medicine, Tel Aviv University, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., N.M.B., G.I., E.S., D.T.).
authors.forename: Salo
authors.initials: S
authors.lastname: Haratz
authors.affiliation: From the Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., D.T.); Department of Neurology, Elias Sourasky Medical Center, Tel Aviv, Israel (N.M.B.); Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel (G.I.); Israeli Association for Cardiovascular Trials, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel (M.E., D.G.); and Sackler Faculty of Medicine, Tel Aviv University, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., N.M.B., G.I., E.S., D.T.).
authors.forename: Shlomi
authors.initials: S
authors.lastname: Peretz
authors.affiliation: From the Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., D.T.); Department of Neurology, Elias Sourasky Medical Center, Tel Aviv, Israel (N.M.B.); Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel (G.I.); Israeli Association for Cardiovascular Trials, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel (M.E., D.G.); and Sackler Faculty of Medicine, Tel Aviv University, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., N.M.B., G.I., E.S., D.T.).
authors.forename: Natan M
authors.initials: NM
authors.lastname: Bornstein
authors.affiliation: From the Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., D.T.); Department of Neurology, Elias Sourasky Medical Center, Tel Aviv, Israel (N.M.B.); Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel (G.I.); Israeli Association for Cardiovascular Trials, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel (M.E., D.G.); and Sackler Faculty of Medicine, Tel Aviv University, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., N.M.B., G.I., E.S., D.T.).
authors.forename: Gal
authors.initials: G
authors.lastname: Ifergane
authors.affiliation: From the Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., D.T.); Department of Neurology, Elias Sourasky Medical Center, Tel Aviv, Israel (N.M.B.); Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel (G.I.); Israeli Association for Cardiovascular Trials, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel (M.E., D.G.); and Sackler Faculty of Medicine, Tel Aviv University, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., N.M.B., G.I., E.S., D.T.).
authors.forename: Michal
authors.initials: M
authors.lastname: Einhorn
authors.affiliation: From the Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., D.T.); Department of Neurology, Elias Sourasky Medical Center, Tel Aviv, Israel (N.M.B.); Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel (G.I.); Israeli Association for Cardiovascular Trials, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel (M.E., D.G.); and Sackler Faculty of Medicine, Tel Aviv University, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., N.M.B., G.I., E.S., D.T.).
authors.forename: Ehud
authors.initials: E
authors.lastname: Schwammenthal
authors.affiliation: From the Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., D.T.); Department of Neurology, Elias Sourasky Medical Center, Tel Aviv, Israel (N.M.B.); Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel (G.I.); Israeli Association for Cardiovascular Trials, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel (M.E., D.G.); and Sackler Faculty of Medicine, Tel Aviv University, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., N.M.B., G.I., E.S., D.T.).
authors.forename: Diklah
authors.initials: D
authors.lastname: Geva
authors.affiliation: From the Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., D.T.); Department of Neurology, Elias Sourasky Medical Center, Tel Aviv, Israel (N.M.B.); Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel (G.I.); Israeli Association for Cardiovascular Trials, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel (M.E., D.G.); and Sackler Faculty of Medicine, Tel Aviv University, Israel (Y.S., R.T., D.O., O.M., S.H., S.P., N.M.B., G.I., E.S., D.T.).
authors.forename: David
authors.initials: D
authors.lastname: Tanne
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D002545:Brain Ischemia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data*; D018570:Risk Assessment; D055502:Secondary Prevention; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants
keywords: atrial fibrillation; brain ischemia; odds ratio; stroke; survivors