Antiplatelet patterns and outcomes in patients with atrial fibrillation not prescribed an anticoagulant after stroke

Kay Won Chang, Ying Xian, Xin Zhao, Xiaojuan Mi, Roland Matsouaka, Lee H. Schwamm, Shreyansh Shah, Barbara L. Lytle, Eric E. Smith, Deepak L. Bhatt, Gregg C. Fonarow, Jonathan C. Hsu

Research output: Contribution to journalArticlepeer-review

Abstract

Background: To determine association of discharge antiplatelet therapy prescription with 1-year outcomes among patients with AF admitted with acute ischemic stroke and discharged without oral anticoagulation. Methods: In a retrospective cohort study from the Get With The Guidelines-Stroke registry, we identified all Medicare fee-for-service beneficiaries 65 years or older with AF or atrial flutter admitted with acute ischemic stroke and discharged without oral anticoagulation from April 2003 through December 2014, and we determined association of discharge antiplatelet therapy prescription with 1-year outcomes using Medicare claims data. Primary outcomes were 1-year mortality and composite endpoint of major adverse cardiovascular/neurologic/bleeding events (MACNBE). Results: Of 64,228 subjects (median [interquartile range] age, 84 [78–89] years; 62.5% female), 54,621 (85.0%) were discharged with antiplatelet therapy, and 9607 (15.0%) were discharged with no antithrombotic therapy. The unadjusted rates of 1-year mortality were lower among patients receiving antiplatelet therapy (37.3%) than among those receiving no antithrombotic therapy (48.1%); unadjusted rates of MACNBE were lower for those receiving antiplatelet therapy (45.5%) compared with those receiving no antithrombotic therapy (55.2%). After adjusting for potential confounders, antiplatelet therapy prescription was associated with reduced 1-year mortality (adjusted hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.62–0.66, P <.001) and MACNBE (adjusted HR 0.69, 95% CI 0.67–0.71, P <.001). Conclusions: Among Medicare beneficiaries with AF admitted for acute ischemic stroke but not discharged on oral anticoagulant therapy, antiplatelet therapy, compared with no antithrombotic therapy, was associated with reduced 1-year mortality and MACNBE.

Original languageEnglish (US)
Pages (from-to)88-94
Number of pages7
JournalInternational Journal of Cardiology
Volume321
DOIs
StatePublished - Dec 15 2020
Externally publishedYes

Keywords

  • Acute ischemic stroke
  • Antiplatelet
  • Atrial fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint

Dive into the research topics of 'Antiplatelet patterns and outcomes in patients with atrial fibrillation not prescribed an anticoagulant after stroke'. Together they form a unique fingerprint.

Cite this