AUTHOR=Gong Xiaoxian , Chen Hongfang , Wang Jianan , Zhong Wansi , Chen Luowei , Yan Shenqiang , Lou Min 

TITLE=Undertreatment of Anticoagulant Therapy in Hospitalized Acute Ischemic Stroke Patients With Atrial Fibrillation

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.841020

DOI=10.3389/fcvm.2022.841020

ISSN=2297-055X

ABSTRACT=Background: This study aimed to investigate the prevalence and factors associated with the initiation of anticoagulation among acute ischemic stroke (AIS) patients with atrial fibrillation (AF) at discharge in China.
Methods: We continuously included hospitalized AIS patients with AF diagnosis registered in the Computer-based Online Database of Acute Stroke Patients for Stroke Management Quality Evaluation (CASE II) from January 2016 to December 2020 and divided them into anticoagulant and non-anticoagulant group according to the medications at discharge. Binary logistic regression was used to determine the factors associated with the prescription of anticoagulants in AF patients.  
Results: A total of 16,162 patients were enrolled, mean age was 77±9 years, 8596 (53.2%) were males; median baseline National Institute of Health Stroke Scale score was 5 (2-12). Of the 14838 patients without contraindications of antithrombotic therapy, 6335 (42.7%) patients initiated anticoagulation at discharge. Prior history of hemorrhagic stroke (OR 0.646, P <0.001) and gastrointestinal bleeding (OR 0.607, P =0.002) were associated with lower rate of anticoagulation at discharge. Patients with any intracranial hemorrhage (OR 0.268, P <0.001) or pneumonia during hospitalization (OR 0.601, P <0.001) were less likely to receive anticoagulants at discharge. Among 7807 patients with previously diagnosed AF and high risk of stroke (CHA2DS2-VASc ≥2), only 1585 (20.3%) patients had been receiving anticoagulation prior to the onset of stroke. However, the mean INR was 1.5 on the first test during hospitalization in these patients receiving warfarin. Patients complicated with previous history of ischemic stroke/TIA (OR 2.175, P <0.001) and peripheral artery disease (OR 1.436, P =0.002) were more common to start anticoagulants.
Conclusions: Less than half of AIS patients with AF initiated guideline recommended anticoagulation at discharge, while only 20% previously diagnosed AF patients with high risk of stroke had been using anticoagulants prior to the onset of stroke, which highlights a large care gap in hospitalized stroke patients and the importance of AF management.