Antithrombotic therapy use at discharge and 1 year in patients with atrial fibrillation and acute stroke: Results from the AVAIL registry

Renato D. Lopes, Bimal R. Shah, Daiwai M. Olson, Xin Zhao, Wenqin Pan, Cheryl D. Bushnell, Eric D. Peterson

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background and Purpose: Current American Heart Association/American Stroke Association guidelines identify warfarin use as a class IA indication in patients with atrial fibrillation (AF) and ischemic stroke (IS) or transient ischemic attack (TIA). However, few studies have examined factors associated with long-term antithrombotic therapy use in IS/TIA patients with AF. Methods: We utilized the Get With The Guidelines-Stroke national quality improvement registry and the Adherence eValuation After Ischemic Stroke Longitudinal (AVAIL) Registry to examine patterns of antithrombotic use at discharge and at 12 months in IS/TIA patients with AF. A multivariate logistic regression model was developed to identify predictors of warfarin use in this patient population at 12 months. Results: Of the 2460 IS/TIA patients, 291 (11.8%) had AF, of which 5.5% of patients were discharged on aspirin alone, 49.1% on warfarin alone, 1.4% on clopidogrel alone, 34.7% on warfarin plus aspirin, 2.1% on aspirin plus clopidogrel, and 1.0% on aspirin plus clopidogrel plus warfarin. Paradoxically, there was a decrease in the rate of warfarin use in patients with a CHADS 2 score >3. The only factor associated with warfarin use at 12-month follow-up was male gender (adjusted odds ratio, 2.27; confidence interval, 1.22-4.35; P=0.01). Conclusions: Overall, the use of warfarin therapy is high at discharge in IS/TIA patients with AF; however, there was a decrease in the rate of warfarin use in patients with a CHADS 2 score >3. Compared to women, men were more likely to be on warfarin at 1 year after the index stroke event. Therefore, opportunities exist to improve antithrombotic use in all IS/TIA patients with AF.

Original languageEnglish (US)
Pages (from-to)3477-3483
Number of pages7
JournalStroke
Volume42
Issue number12
DOIs
StatePublished - Dec 2011

Fingerprint

Warfarin
Atrial Fibrillation
Registries
Stroke
clopidogrel
Transient Ischemic Attack
Aspirin
Therapeutics
Logistic Models
Guidelines
Quality Improvement
Odds Ratio
Confidence Intervals

Keywords

  • Antithrombotic therapy
  • Atrial fibrillation
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Antithrombotic therapy use at discharge and 1 year in patients with atrial fibrillation and acute stroke : Results from the AVAIL registry. / Lopes, Renato D.; Shah, Bimal R.; Olson, Daiwai M.; Zhao, Xin; Pan, Wenqin; Bushnell, Cheryl D.; Peterson, Eric D.

In: Stroke, Vol. 42, No. 12, 12.2011, p. 3477-3483.

Research output: Contribution to journalArticle

Lopes, Renato D. ; Shah, Bimal R. ; Olson, Daiwai M. ; Zhao, Xin ; Pan, Wenqin ; Bushnell, Cheryl D. ; Peterson, Eric D. / Antithrombotic therapy use at discharge and 1 year in patients with atrial fibrillation and acute stroke : Results from the AVAIL registry. In: Stroke. 2011 ; Vol. 42, No. 12. pp. 3477-3483.
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abstract = "Background and Purpose: Current American Heart Association/American Stroke Association guidelines identify warfarin use as a class IA indication in patients with atrial fibrillation (AF) and ischemic stroke (IS) or transient ischemic attack (TIA). However, few studies have examined factors associated with long-term antithrombotic therapy use in IS/TIA patients with AF. Methods: We utilized the Get With The Guidelines-Stroke national quality improvement registry and the Adherence eValuation After Ischemic Stroke Longitudinal (AVAIL) Registry to examine patterns of antithrombotic use at discharge and at 12 months in IS/TIA patients with AF. A multivariate logistic regression model was developed to identify predictors of warfarin use in this patient population at 12 months. Results: Of the 2460 IS/TIA patients, 291 (11.8{\%}) had AF, of which 5.5{\%} of patients were discharged on aspirin alone, 49.1{\%} on warfarin alone, 1.4{\%} on clopidogrel alone, 34.7{\%} on warfarin plus aspirin, 2.1{\%} on aspirin plus clopidogrel, and 1.0{\%} on aspirin plus clopidogrel plus warfarin. Paradoxically, there was a decrease in the rate of warfarin use in patients with a CHADS 2 score >3. The only factor associated with warfarin use at 12-month follow-up was male gender (adjusted odds ratio, 2.27; confidence interval, 1.22-4.35; P=0.01). Conclusions: Overall, the use of warfarin therapy is high at discharge in IS/TIA patients with AF; however, there was a decrease in the rate of warfarin use in patients with a CHADS 2 score >3. Compared to women, men were more likely to be on warfarin at 1 year after the index stroke event. Therefore, opportunities exist to improve antithrombotic use in all IS/TIA patients with AF.",
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AU - Lopes, Renato D.

AU - Shah, Bimal R.

AU - Olson, Daiwai M.

AU - Zhao, Xin

AU - Pan, Wenqin

AU - Bushnell, Cheryl D.

AU - Peterson, Eric D.

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