Nine‐year trend of oral anticoagulant use in patients with embolic stroke due to nonvalvular atrial fibrillation
Open Access
- 20 July 2020
- journal article
- research article
- Published by Wiley in Journal of Arrhythmia
- Vol. 36 (5), 883-889
- https://doi.org/10.1002/joa3.12402
Abstract
Background Direct oral anticoagulants (DOACs) are increasingly used as an alternative to warfarin in patients with nonvalvular atrial fibrillation (NVAF). However, whether there is sufficient prescription of oral anticoagulants (OACs) to decrease the incidence of embolic stroke remains unclear. Methods and Results We conducted a retrospective observational study of patients hospitalized with ischemic stroke between January 1, 2010 and December 31, 2018. During the 8 years, the annual incidence ratio of embolic stroke to all ischemic strokes did not decrease over time (21‐33%) except for that in 2018. The proportion of OAC users did not also change over time (from 23% to 45% [overall 31%], P = .78). Among the OAC users, 19% patients were warfarin users, and 12% patients were DOAC users. In 73% of warfarin users, prothrombin time was subtherapeutic, whereas in 60% of DOAC users, the dose was adequately prescribed. OACs were prescribed more often in patients with high CHADS2 score than in those with low score (P = .01). The number of patients who had no medical history of a doctor visit before admission increased significantly in the recent period of 2015‐2018 (22% vs 8% in the previous period of 2010‐2014) (P = .01). Conclusions The incidence of embolic stroke patients without OACs did not decrease over time, and OACs in patients with NVAF have not been sufficient, even in DOAC era. In recent years, the incidence of undiagnosed AF has increased. To prevent embolic stroke, a correct AF diagnosis beforehand is important.Keywords
This publication has 16 references indexed in Scilit:
- Clinical Characteristics and Outcomes in Extreme Elderly (Age ≥ 85 Years) Japanese Patients With Atrial FibrillationSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2016
- Nine-Year Trend of Anticoagulation Use, Thromboembolic Events, and Major Bleeding in Patients With Non-Valvular Atrial Fibrillation – Shinken Database Analysis –Circulation Journal, 2016
- Trends in Oral Anticoagulant Choice for Acute Stroke Patients with Nonvalvular Atrial Fibrillation in Japan: The SAMURAI-NVAF StudyInternational Journal of Stroke, 2015
- Incidence of Ischemic Stroke in Japanese Patients With Atrial Fibrillation Not Receiving Anticoagulation TherapyCirculation Journal, 2015
- 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive SummaryCirculation, 2014
- 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive SummaryJournal of the American College of Cardiology, 2014
- Guidelines for Pharmacotherapy of Atrial Fibrillation (JCS 2013)Circulation Journal, 2014
- Target International Normalized Ratio Values for Preventing Thromboembolic and Hemorrhagic Events in Japanese Patients With Non-Valvular Atrial FibrillationCirculation Journal, 2013
- Effect of Intensity of Oral Anticoagulation on Stroke Severity and Mortality in Atrial FibrillationThe New England Journal of Medicine, 2003
- Optimal Intensity of International Normalized Ratio in Warfarin Therapy for Secondary Prevention of Stroke in Patients with Non-valvular Atrial Fibrillation.Internal Medicine, 2001