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Cardiovascular medicine
Research
Anticoagulation therapy in patients with stroke and atrial fibrillation: a registry-based study of acute stroke care in Surrey, UK
  1. Thang S Han1,
  2. Christopher Henry Fry2,
  3. David Fluck3,
  4. Brendan Affley4,
  5. Giosue Gulli4,
  6. Christopher Barrett5,
  7. Puneet Kakar6,
  8. Tasmin Patel1,
  9. Sapna Sharma1,
  10. Pankaj Sharma1
  1. 1 Institute of Cardiovascular Research, Royal Holloway, University of London, London, UK
  2. 2 School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
  3. 3 Department of Cardiology, Ashford and St Peter’s NHS Foundation Trust, Chertsey, UK
  4. 4 Department of Stroke, Ashford and Saint Peter’s Hospitals NHS Trust, Chertsey, UK
  5. 5 Department of Stroke, NHS Frimley Health Foundation Trust, Frimley, UK
  6. 6 Department of Stroke, Epsom and St Helier University Hospitals, Epsom, UK
  1. Correspondence to Dr Thang S Han; t.s.han{at}doctors.org.uk

Abstract

Introduction Because of their high risk of stroke, anticoagulation therapy is recommended for most patients with atrial fibrillation (AF). The present study evaluated the use of anticoagulants in the community and in a hospital setting for patients with AF and its associations with stroke.

Methods Patients admitted with stroke to four major hospitals in County of Surrey, England were surveyed in the 2014–2016 Sentinel Stroke National Audit Programme. Descriptive statistics was used to summarise subject characteristics and χ² test to assess differences between categorical variables.

Results A total of 3309 patients, 1656 men (mean age: 73.1 years±SD 13.2) and 1653 women (79.3 years±13.0) were admitted with stroke (83.3% with ischaemic, 15.7% haemorrhagic stroke and 1% unspecified). AF occurred more frequently (χ2=62.4; p<0.001) among patients admitted with recurrent (30.2%) rather than with first stroke (17.1%). There were 666 (20.1%) patients admitted with a history of AF, among whom 304 (45.3%) were anticoagulated, 279 (41.9%) were untreated and 85 (12.8%) deemed unsuitable for anticoagulation. Of the 453 patients with history of AF admitted with a first ischaemic stroke, 138 (37.2%) were on anticoagulation and 41 (49.6%) were not (χ2 = 6.3; p<0.043) and thrombolysis was given more frequently for those without prior anticoagulation treatment (16.1%) or unsuitable for anticoagulation (23.6%) compared with those already on anticoagulation treatment (8.3%; χ2=10.0; p=0.007). Of 2643 patients without a previous history of AF, 171 (6.5%) were identified with AF during hospitalisation. Of patients with AF who presented with ischaemic stroke who were not anticoagulated or deemed unsuitable for anticoagulation prior to admission, 91.8% and 75.0%, respectively, were anticoagulated on discharge.

Conclusions The study highlights an existing burden for patients with stroke and reflects inadequate treatment of AF which results in an increased stroke burden. There is significant scope to improve the rates of anticoagulation.

  • stroke medicine
  • cardiology
  • adult cardiology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:©http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-022558

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    Footnotes

    • Contributors TSH and PS reviewed the topic related literature, performed the study concept and analysis design. BA, GG, CB, PK and TP performed the study coordination and data collection. TSH wrote the first draft, analysed and interpreted the data and revised the manuscript. CHF, DF, SS and PS edited the manuscript. All authors checked, interpreted results and approved the final version. TSH and PS are the guarantors for the study.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.