AF-Related Stroke and Anticoagulation

Jul 18, 2018
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Authors:
Cowan JC, Wu J, Hall M, et al.
Citation:
A 10 Year Study of Hospitalized Atrial Fibrillation-Related Stroke in England and Its Association With Uptake of Oral Anticoagulation. Eur Heart J 2018;Jul 5:[Epub ahead of print].
Summary By:
Fred Morady, MD, FACC

Study Questions:

Have changes in the use of anticoagulants affected the stroke rate in patients with atrial fibrillation (AF)?

Methods:

The data for this study were obtained from a national database in England covering 2006-2016. The weekly rates of hospitalizations for AF-related strokes and AF were quantitated and the use of oral anticoagulants was tracked.

Results:

Hospitalizations for AF-related stroke increased from 80/week in 2006 to 98/week in 2011 then declined to 86/week in 2016. During those 10 years, the use of oral anticoagulants in AF patients with a CHA2DS2-VASc score ≥2 increased from 48% to 78.6%, with most of the increase occurring after 2011. After adjustment for AF prevalence, sex, age, and co-morbidities, every 1% increase in the use of an oral anticoagulant was found to be associated with a 0.8% reduction in the weekly AF-related stroke rate.

Conclusions:

The more widespread usage of oral anticoagulants among at-risk AF patients in England in 2006-2016 has been associated with a reduction in the rate of hospitalizations due to AF-related stroke.

Perspective:

Although this study does not present direct evidence that the reduction in AF-related stroke hospitalizations resulted from increased usage of oral anticoagulants, this conclusion is entirely plausible. The two factors most likely to account for the more widespread usage of oral anticoagulants in at-risk AF patients in England, especially after 2011, were the introduction of direct oral anticoagulants and national education initiatives aimed at increasing the use of anticoagulants in AF patients with a CHA2DS2-VASc score ≥2. Given the persistent underutilization of oral anticoagulants in at-risk AF patients in the United States, a case can be made for instituting similar educational programs directed at care providers.

Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Blood Coagulation, Hospitalization, Risk, Secondary Prevention, Stroke, Thrombolytic Therapy, Vascular Diseases


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