Afib Post-Stroke OAC Tied to Fewer Long-Term Events

I wish this would be written up into an understandable stroke protocol. That way stroke survivors could refer to AFIB101 and ask their doctor how it applies to them. Right now survivors are relying on doctors to know the latest in stroke. That has been proven many times to be completely false, they basically know nothing since medical school.  You're screwed.
https://www.medpagetoday.com/cardiology/arrhythmias/72976?

No increased risk of bleeding complications in Danish registry

• by Judy George, Contributing Writer, MedPage Today May 18, 2018

Atrial fibrillation (Afib) patients who received post-stroke oral anticoagulation therapy had significantly lower risk of a new thromboembolic event without increased risk of bleeding complications, an observational study from Denmark found.
Over a median of 2.2 years, the risk of a subsequent stroke (adjusted HR 0.81; 95% CI 0.73 to 0.89) and death (adjusted HR 0.68; 95% CI, 0.65 to 0.72) for Afib patients was significantly lower among those treated with oral anticoagulants compared with no antithrombotic therapy, according to Anna Gundlund, MD, of Herlev and Gentofte Hospital in Hellerup, Denmark, and colleagues.
Only 36.3% of Afib patients received oral anticoagulation therapy before their stroke and 52.5% received it after, although treatment rates improved over time, they reported online in JAMA Network Open.
"Our findings suggest a substantial opportunity for improving primary and secondary stroke prophylaxis in high-risk patients with Afib," they wrote.
In the U.S., Afib patients account for a growing proportion of ischemic strokes. Significant underuse of anticoagulation has been reported both in the U.S. and Europe: Nearly 40% of Afib patients who should receive an oral anticoagulant are wrongly given aspirin, a recent analysis of the American College of Cardiology's PINNACLE registry showed.
In this retrospective study of people with Afib from the Danish National Patient Registry, Gundlund and colleagues evaluated 30,626 patients who had a pre-stroke CHA₂DS₂-VASc score of 1 or higher for men and 2 or higher for women from 2004 to 2017. In 2010, European guidelines changed to recommend oral anticoagulants instead of aspirin for stroke prevention in Afib patients. (The study reflected this change, but even so, the percentage of eligible patients who did not receive any antithrombotic therapy remained about 23% in later years.)
The researchers looked at three groups of patients: those treated with oral anticoagulation therapy, those treated with antiplatelet therapy alone, or those who received no antithrombotic treatment. Patients were a median of 81 years old and 50.8% were female.
During a maximum of 10 years of follow up, 17.5%, 21.2%, and 21.5% of patients experienced a new thromboembolic event and 72.7%, 86.4%, and 86.2% died among those treated with oral anticoagulation therapy, antiplatelet therapy, or no antithrombotic therapy, respectively.
Post-stroke oral anticoagulation was associated not only with lower risk of recurrent thromboembolic events, but no significant difference in bleeding complications compared with no post-stroke antithrombotic therapy (adjusted HR 0.97; 95% CI 0.86 to 1.10).
This analysis expands previous findings about preventive strategies for Afib patients and also "brings focus to a lack of guideline-adherent prescription of oral anticoagulation immediately after stroke," observed Jonathan Hsu, MD, of the University of California San Diego, who was not involved in the study.
"As clinicians, we need to realize that a lack of oral anticoagulation prescription in patients with atrial fibrillation at risk for stroke puts our patients at a disservice, and we need to increase awareness of proper preventative therapies," he told MedPage Today.
The authors listed several limitations to their research. They examined all types of Afib, including Afib secondary to other conditions, which may have influenced physicians' choice of antithrombotic therapy. No information on labile international normalized ratio was available for this population, possibly leading to an overestimation of patients receiving adequate oral anticoagulation therapy, they noted. Results also may have been influenced by patient compliance.

Gundlund reported receiving research funding from Bristol-Myers Squibb. Co-authors reported relationships with Janssen Pharmaceuticals, Daiichi Sankyo, Genentech, AstraZeneca, Bayer Corp, Bristol-Myers Squibb, Boehringer Ingelheim, Novo Nordisk, and Biotronic.

• Primary Source

  JAMA Network Open

  Source Reference: Gundland A, et al "Prestroke and poststroke antithrombotic therapy in patients with atrial fibrillation: Results from a nationwide cohort" JAMA Network Open 2018; DOI:10.1001/jamanetworkopen.2018.017.