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Associations with anticoagulation: a cross-sectional registry-based analysis of stroke survivors with atrial fibrillation
  1. Azmil H Abdul-Rahim1,
  2. Jao Wong2,
  3. Christine McAlpine3,
  4. Camilla Young3,
  5. Terence J Quinn1
  1. 1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  2. 2Medical School, University of Glasgow, Glasgow, UK
  3. 3NHS Greater Glasgow and Clyde, Stroke Managed Clinical Network, Glasgow, UK
  1. Correspondence to Dr Azmil H Abdul-Rahim, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G11 6NT, UK; Azmil.Abdul-Rahim{at}glasgow.ac.uk

Abstract

Objective To describe vitamin K antagonist (VKA) anticoagulation prescribing patterns in stroke survivors with atrial fibrillation (AF), with particular emphasis on sociodemographic associations with VKA prescription.

Methods We conducted a cross-sectional analysis of city-wide Glasgow primary care data held as part of the Local Enhanced Services (LES) for the year 2010. We collated clinical and sociodemographic data of community-dwelling ischaemic stroke survivors with AF, including risk factors; comorbidity; socioeconomic status and prescribing. We described stroke risk and bleeding risk using recommended stratification tools (CHA2DS2-VASC and HAS-BLED). Univariate and multivariate associations with anticoagulant prescription were described by ORs and corresponding 95% CI.

Results We identified 3429 community-dwelling, ischaemic stroke survivors with AF; median age 78 (IQR 72–84); 1699 (49%) male. Median CHA2DS2-VASC score was 5 (IQR 4–6). VKA was prescribed in 1165 (34%). On univariate analysis, higher CHA2DS2-VASC was associated with fewer VKA prescriptions (OR 0.90, 95% CI 0.45 to 0.95). On multivariate analysis, older age (OR 0.97, 95% CI 0.96 to 0.98) and higher deprivation scores (OR 0.59, 95% CI 0.57 to 0.76) were independently associated with non-prescription of VKA.

Conclusions Anticoagulation was underused in this high-risk population, and those at highest risk were less likely to be treated. Strategies need to be developed to improve prescription of anticoagulation treatment.

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