1
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Yang M, Cheng H, Wang X, Ouyang M, Shajahan S, Carcel C, Anderson C, Kristoffersen ES, Lin Y, Sandset EC, Wang X, Yang J. Antithrombotics prescription and adherence among stroke survivors: A systematic review and meta-analysis. Brain Behav 2022; 12:e2752. [PMID: 36067030 PMCID: PMC9575604 DOI: 10.1002/brb3.2752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/09/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES We aimed to investigate the prescription of antithrombotic drugs (including anticoagulants and antiplatelets) and medication adherence after stroke. METHODS We performed a systematic literature search across MEDLINE and Embase, from January 1, 2015, to February 17, 2022, to identify studies reporting antithrombotic medications (anticoagulants and antiplatelets) post stroke. Two people independently identified reports to include, extracted data, and assessed the quality of included studies according to the Newcastle-Ottawa scale. Where possible, data were pooled using random-effects meta-analysis. RESULTS We included 453,625 stroke patients from 46 studies. The pooled proportion of prescribed antiplatelets and anticoagulants among patients with atrial fibrillation (AF) was 62% (95% CI: 57%-68%), and 68% (95% CI: 58%-79%), respectively. The pooled proportion of patients who were treated according to the recommendation of guidelines of antithrombotic medications from four studies was 67% (95% CI: 41%-93%). It was reported that 11% (95% CI: 2%-19%) of patients did not receive antithrombotic medications. Good adherence to antiplatelet, anticoagulant, and antithrombotic medications was 78% (95% CI: 67%-89%), 71% (95% CI: 57%-84%), and 73% (95% CI: 59%-86%), respectively. CONCLUSION In conclusion, we found that less than 70% of patients were prescribed and treated according to the recommended guidelines of antithrombotic medications, and good adherence to antithrombotic medications is only 73%. Prescription rate and good adherence to antithrombotic medications still need to be improved among stroke survivors.
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Affiliation(s)
- Min Yang
- Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Hang Cheng
- Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Xia Wang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Menglu Ouyang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Sultana Shajahan
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Cheryl Carcel
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, The University of Sydney, NSW, Australia
| | - Craig Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, The University of Sydney, NSW, Australia.,The George Institute China at Peking University Health Science Centre, Beijing, PR China
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway.,Department of General Practice, Helsam, University of Oslo, Oslo, Norway
| | - Yapeng Lin
- Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China.,International Clinical Research Center, Chengdu Medical College, Chengdu, China
| | - Else Charlotte Sandset
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway.,The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Xiaoyun Wang
- Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jie Yang
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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2
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Deceptive Adherence to Anticoagulation in Secondary Stroke Prevention. Stroke Res Treat 2022; 2022:5318259. [PMID: 35859782 PMCID: PMC9293572 DOI: 10.1155/2022/5318259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/17/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background Oral anticoagulants (OAC) effectively reduce the risk for ischemic stroke in patients with atrial fibrillation (AF). We aimed to assess OAC treatment adherence in secondary stroke prevention and to find predictors of adherence using individualized patient data. Methods This retrospective cohort study included patients with a discharge diagnosis of ischemic stroke and AF from Tartu University Hospital from 2017 to 2018. Data from patient charts and the Electronic Hospital Information, Estonian Electronic Prescription, and Estonian Electronic Health Record systems were registered. Results Of the 353 patients, 237 (67%) were prescribed OAC treatment at discharge and during the first year after stroke, 202 (85%) of them used OAC treatment. The mean adherence was 81%, while only 68% had good adherence. Reduced non-vitamin K antagonist OAC (NOAC) dose was used in 68 patients (39%), which was justified in 23 (34%). First-ever stroke occurrence was the only significant factor for good treatment adherence in logistic regression analysis. There were 47 patients (23%) with complications among the patients on OAC treatment. Majority of the patients (70%) with hemorrhagic complications and 52% of patients with thromboembolic complications had good treatment adherence Conclusions Our study showed that OAC treatment adherence following stroke was modest and first-ever stroke was the only predictor of good or full treatment adherence.
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Ganesh A, Ospel JM, Marko M, van Zwam WH, Roos YBWEM, Majoie CBLM, Goyal M. From Three-Months to Five-Years: Sustaining Long-Term Benefits of Endovascular Therapy for Ischemic Stroke. Front Neurol 2021; 12:713738. [PMID: 34381418 PMCID: PMC8350336 DOI: 10.3389/fneur.2021.713738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022] Open
Abstract
Background and Purpose: During the months and years post-stroke, treatment benefits from endovascular therapy (EVT) may be magnified by disability-related differences in morbidity/mortality or may be eroded by recurrent strokes and non-stroke-related disability/mortality. Understanding the extent to which EVT benefits may be sustained at 5 years, and the factors influencing this outcome, may help us better promote the sustenance of EVT benefits until 5 years post-stroke and beyond. Methods: In this review, undertaken 5 years after EVT became the standard of care, we searched PubMed and EMBASE to examine the current state of the literature on 5-year post-stroke outcomes, with particular attention to modifiable factors that influence outcomes between 3 months and 5 years post-EVT. Results: Prospective cohorts and follow-up data from EVT trials indicate that 3-month EVT benefits will likely translate into lower 5-year disability, mortality, institutionalization, and care costs and higher quality of life. However, these group-level data by no means guarantee maintenance of 3-month benefits for individual patients. We identify factors and associated “action items” for stroke teams/systems at three specific levels (medical care, individual psychosocioeconomic, and larger societal/environmental levels) that influence the long-term EVT outcome of a patient. Medical action items include optimizing stroke rehabilitation, clinical follow-up, secondary stroke prevention, infection prevention/control, and post-stroke depression care. Psychosocioeconomic aspects include addressing access to primary care, specialist clinics, and rehabilitation; affordability of healthy lifestyle choices and preventative therapies; and optimization of family/social support and return-to-work options. High-level societal efforts include improving accessibility of public/private spaces and transportation, empowering/engaging persons with disability in society, and investing in treatments/technologies to mitigate consequences of post-stroke disability. Conclusions: In the longtime horizon from 3 months to 5 years, several factors in the medical and societal spheres could negate EVT benefits. However, many factors can be leveraged to preserve or magnify treatment benefits, with opportunities to share responsibility with widening circles of care around the patient.
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Affiliation(s)
- Aravind Ganesh
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | | | - Martha Marko
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Wim H van Zwam
- Department of Radiology, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | | | - Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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4
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Haeusler KG, Tütüncü S, Kunze C, Schurig J, Malsch C, Harder J, Wiedmann S, Dimitrijeski B, Ebinger M, Hagemann G, Hamilton F, Honermann M, Jungehulsing GJ, Kauert A, Koennecke HC, Leithner C, Mackert BM, Masuhr F, Nabavi D, Rocco A, Schmehl I, Schmitz B, Sparenberg P, Stingele R, von Brevern M, Völzke E, Dietzel J, Heuschmann PU, Endres M. Oral anticoagulation in patients with atrial fibrillation and acute ischaemic stroke: design and baseline data of the prospective multicentre Berlin Atrial Fibrillation Registry. Europace 2020; 21:1621-1632. [PMID: 31397475 DOI: 10.1093/europace/euz199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/28/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS The Berlin Atrial Fibrillation Registry was designed to analyse oral anticoagulation (OAC) prescription in patients with atrial fibrillation (AF) and acute ischaemic stroke. METHODS AND RESULTS This investigator-initiated prospective multicentre registry enrolled patients at all 16 stroke units located in Berlin, Germany. The ongoing telephone follow-up is conducted centrally and will cover 5 years per patient. Within 2014 and 2016, 1080 patients gave written informed consent and 1048 patients were available for analysis. Median age was 77 years [interquartile range (IQR) 72-83], 503 (48%) patients were female, and 254 (24%) had a transient ischaemic attack (TIA). Overall, 470 (62%) out of 757 patients with known AF and a (pre-stroke) CHA2DS2-VASc ≥ 1 were anticoagulated at the time of stroke. At hospital discharge, 847 (81.3%) of 1042 patients were anticoagulated. Thereof 710 (68.1%) received a non-vitamin K-dependent oral anticoagulant (NOAC) and 137 (13.1%) a vitamin K antagonist (VKA). Pre-stroke intake of a NOAC [odds ratio (OR) 15.6 (95% confidence interval, 95% CI 1.97-122)] or VKA [OR 0.04 (95% CI 0.02-0.09)], an index TIA [OR 0.56 (95% CI 0.34-0.94)] rather than stroke, heart failure [OR 0.49 (95% CI 0.26-0.93)], and endovascular thrombectomy at hospital admission [OR 12.9 (95% CI 1.59-104)] were associated with NOAC prescription at discharge. Patients' age or AF type had no impact on OAC or NOAC use, respectively. CONCLUSION About 60% of all registry patients with known AF received OAC at the time of stroke or TIA. At hospital discharge, more than 80% of AF patients were anticoagulated and about 80% of those were prescribed a NOAC.
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Affiliation(s)
- Karl Georg Haeusler
- Department of Neurology, Universitätsklinikum Würzburg, Josef-Schneider-Str. 11, Würzburg, Germany
| | - Serdar Tütüncü
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany
| | - Claudia Kunze
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany
| | - Johannes Schurig
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
| | - Carolin Malsch
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Germany.,Comprehensive Heart Failure Center, University of Würzburg, Clinical Trial Centre Würzburg, University Hospital Würzburg, Germany
| | - Janek Harder
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Germany
| | - Silke Wiedmann
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Germany.,Strategic Corporate Development, Charité-Universitätsmedizin Berlin, Germany
| | | | - Martin Ebinger
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany.,Department of Neurology, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Georg Hagemann
- Department of Neurology, Helios Klinik Berlin-Buch, Berlin, Germany
| | - Frank Hamilton
- Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Martin Honermann
- Department of Neurology, Vivantes Klinikum Spandau, Berlin, Germany
| | - Gerhard Jan Jungehulsing
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany.,Department of Neurology, Jüdisches Krankenhaus Berlin, Germany
| | - Andreas Kauert
- Department of Neurology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | | | | | | | - Florian Masuhr
- Department of Neurology, Bundeswehrkrankenhaus Berlin, Germany
| | - Darius Nabavi
- Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Andrea Rocco
- Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
| | - Ingo Schmehl
- Department of Neurology, BG Klinikum Unfallkrankenhaus Berlin, Germany
| | - Bettina Schmitz
- Department of Neurology, Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Paul Sparenberg
- Department of Neurology, BG Klinikum Unfallkrankenhaus Berlin, Germany
| | - Robert Stingele
- Department of Neurology, German Red Cross Hospital Berlin, Köpenick, Germany
| | | | - Enrico Völzke
- Department of Neurology, Schlosspark-Klinik Berlin, Germany
| | - Joanna Dietzel
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Germany.,Comprehensive Heart Failure Center, University of Würzburg, Clinical Trial Centre Würzburg, University Hospital Würzburg, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Partner Site, Berlin, Germany.,German Center for Cardiovascular Diseases (DZHK), Partner Site, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
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5
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Relationship Between Anticoagulant Medication Adherence and Satisfaction in Patients With Stroke. J Neurosci Nurs 2019; 51:229-234. [DOI: 10.1097/jnn.0000000000000463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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6
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Fernandes L, Sargento-Freitas J, Milner J, Silva A, Novo A, Gonçalves T, Marinho AV, Pego GM, Cunha L, António N. Ischemic stroke in patients previously anticoagulated for non-valvular atrial fibrillation: Why does it happen? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2018.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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7
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Bonhorst D. Acidentes tromboembólicos em doentes com fibrilhação auricular sob anticoagulação. Rev Port Cardiol 2019; 38:125-127. [DOI: 10.1016/j.repc.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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8
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Thromboembolic events in patients with atrial fibrillation under anticoagulation. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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9
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Fernandes L, Sargento‐Freitas J, Milner J, Silva A, Novo A, Gonçalves T, Marinho AV, Mariano Pego G, Cunha L, António N. Acidente vascular cerebral isquémico em doentes previamente anticoagulados por fibrilhação auricular não valvular: por que acontece? Rev Port Cardiol 2019; 38:117-124. [DOI: 10.1016/j.repc.2018.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/21/2018] [Accepted: 06/03/2018] [Indexed: 10/27/2022] Open
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10
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Zapata-Wainberg G, Masjuan J, Quintas S, Ximénez-Carrillo Á, García Pastor A, Martínez Zabaleta M, Cardona P, Freijo Guerrero MM, Llull L, Benavente Fernández L, Castellanos Rodrigo M, Egido J, Serena J, Vivancos J. The neurologist's approach to cerebral infarct and transient ischaemic attack in patients receiving anticoagulant treatment for non-valvular atrial fibrillation: ANITA-FA study. Eur J Neurol 2018; 26:230-237. [DOI: 10.1111/ene.13792] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 08/17/2018] [Indexed: 12/18/2022]
Affiliation(s)
- G. Zapata-Wainberg
- Neurology Department; Hospital Universitario de La Princesa; Instituto de Investigación Sanitaria Princesa; Madrid Spain
| | - J. Masjuan
- Neurology Department; Hospital Universitario Ramón y Cajal; Red INVICTUS PLUS; Departamento de Medicina; Universidad de Alcalá (IRYCIS); Madrid Spain
| | - S. Quintas
- Neurology Department; Hospital Universitario de La Princesa; Instituto de Investigación Sanitaria Princesa; Madrid Spain
| | - Á. Ximénez-Carrillo
- Neurology Department; Hospital Universitario de La Princesa; Instituto de Investigación Sanitaria Princesa; Madrid Spain
| | - A. García Pastor
- Neurology Department; Hospital General Universitario Gregorio Marañón; Madrid Spain
| | | | - P. Cardona
- Neurology Department; Hospital Universitari de Bellvitge; Barcelona Spain
| | | | - L. Llull
- Neurology Department; Hospital Universitari Clinic; Barcelona Spain
| | | | | | - J. Egido
- Hospital Clínico Universitario San Carlos; Madrid Spain
| | - J. Serena
- Neurology Department; Hospital Universitario Dr Josep Trueta; Girona Spain
| | - J. Vivancos
- Neurology Department; Hospital Universitario de La Princesa; Red INVICTUS PLUS; Instituto de Investigación Sanitaria La Princesa; Madrid Spain
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11
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Adherence to anticoagulant treatment with apixaban and rivaroxaban in a real environment. ENFERMERIA CLINICA 2017; 28:63-64. [PMID: 28838681 DOI: 10.1016/j.enfcli.2017.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/04/2017] [Indexed: 11/21/2022]
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12
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The impact of anger in adherence to treatment and beliefs about disease 1 year after stroke. J Neurol 2017; 264:1929-1938. [DOI: 10.1007/s00415-017-8577-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/21/2017] [Accepted: 07/24/2017] [Indexed: 01/24/2023]
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13
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Ponce de Leon M, Hohler AD. Safety Considerations During Transitions of Care From Inpatient to Outpatient Settings. Continuum (Minneap Minn) 2017; 23:877-881. [DOI: 10.1212/con.0000000000000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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14
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Simons LA, Ortiz M, Freedman SB, Waterhouse BJ, Colquhoun D, Thomas G. Improved persistence with non-vitamin-K oral anticoagulants compared with warfarin in patients with atrial fibrillation: recent Australian experience. Curr Med Res Opin 2016; 32:1857-1861. [PMID: 27463735 DOI: 10.1080/03007995.2016.1218325] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Long-term anticoagulant therapy in patients with non-valvular atrial fibrillation (AF) is essential to prevent thromboembolic complications, especially ischemic stroke, but treatment persistence with warfarin is poor. This study examines Australian nationwide persistence in AF patients using a non-vitamin-K oral anticoagulant (NOAC) drug. RESEARCH DESIGN AND METHODS We assessed national Pharmaceutical Benefit Scheme records November-December 2013 through March 2015 for prescription of NOAC drugs in a 10% random sample of long-term concession card holders. An historical comparison was made with patients prescribed warfarin in 2008. Key outcome measures were (i) the proportion not filling first repeat prescription and (ii) discontinuation within 12 months. RESULTS A total of 1471 patients with AF were new users of a NOAC drug (228 apixaban, 645 dabigatran, 598 rivaroxaban) and 1348 were new users of warfarin. Mean age on a NOAC was 76 years (58% male), on warfarin 74 years (54% male). Only 9% (95% CI 7-10) failed to collect the first repeat prescription on a NOAC, 30% (27-32) discontinued within 12 months; corresponding proportions on warfarin were 14% (12-16) and 62% (60-65). In a regression model adjusted for age, gender, heart failure, hypertension and diabetes, warfarin-treated patients were 2.5 times more likely to discontinue over 12 months than those who were NOAC treated (hazard ratio =2.47 [95% CI 2.19-2.79]). CONCLUSIONS Persistence with NOAC drugs in patients with AF appears to be superior to warfarin. If continued long-term, this alone will be of clinical importance in the prevention of stroke and death.
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Affiliation(s)
- Leon A Simons
- a UNSW Lipid Research Department , St Vincent's Hospital , Darlinghurst , NSW , Australia
| | - Michael Ortiz
- b UNSW St Vincent's Clinical School , Darlinghurst , NSW , Australia
- c Zitro Consulting Services , Sydney , Australia
| | - S Ben Freedman
- d Sydney Medical School, University of Sydney , Concord Repatriation General Hospital Cardiology Department , NSW , Australia
- e Anzac Institute , Concord , NSW , Australia
| | | | - David Colquhoun
- g University of Queensland, Wesley Medical Centre , Auchenflower , QLD , Australia
| | - Gareth Thomas
- h Pfizer Australia Pty Ltd , West Ryde , NSW , Australia
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15
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Masjuan J, DeFelipe A. Secondary prevention in non-valvular atrial fibrillation patients: a practical approach with edoxaban. Int J Neurosci 2016; 127:716-725. [DOI: 10.1080/00207454.2016.1232256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Jaime Masjuan
- Servicio de Neurologia, Hospital Universitario Ramon y Cajal, Madrid, Spain
- Instituto de Investigación del Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
- Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Alicia DeFelipe
- Servicio de Neurologia, Hospital Universitario Ramon y Cajal, Madrid, Spain
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16
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Hill CE, Varma P, Lenrow D, Price RS, Kasner SE. Reducing Errors in Transition from Acute Stroke Hospitalization to Inpatient Rehabilitation. Front Neurol 2015; 6:227. [PMID: 26579070 PMCID: PMC4621425 DOI: 10.3389/fneur.2015.00227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/12/2015] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Effective stroke care does not end with acute treatment during hospitalization, but extends through rehabilitation and secondary stroke prevention. In transitions across care environments, stroke patients are vulnerable to errors in communication of diagnosis and treatment. This study aimed to demonstrate that formalized communication between the neurology team and the rehabilitation medicine team would promote secondary stroke prevention and minimize interruptions during rehabilitation. METHODS The intervention was a standardized verbal handoff by phone between the discharging neurology resident and the admitting rehabilitation resident regarding each patient at transfer. This retrospective cohort study compared a pre-intervention control group (September 2012 to February 2013) and a post-intervention group transferred with the handoff (September 2013 to January 2014). The outcomes measured included errors in communication of stroke severity, stroke mechanism, medications, and recommended follow-up (appointments and tests) as well as emergent brain imaging, return to the acute care facility, and readmission. RESULTS The pre- and post-intervention groups were similar with respect to number of patients (50 vs. 52) and demographics including gender (52 vs. 54% female), age (65.8 vs. 64.0 years), severity of illness as measured by the National Institutes of Health Stroke Scale (NIHSS) (10 vs. 6.5), and stroke type (84 vs. 77% ischemic). Implementation of the handoff decreased errors in communication of diagnosis (NIHSS 92 vs. 74%, p = 0.02; stroke mechanism 54 vs. 30%, p = 0.02). Furthermore, the handoff decreased the proportion with errors in reconciliation of critical medications (42 vs. 23%, p = 0.04). However, the intervention did not significantly reduce interruptions of the rehabilitation program, such as emergent brain imaging (8 vs. 12%, p = 0.55), or transfers back to the acute care hospital (26 vs. 21%, p = 0.56). CONCLUSION Standardized handoffs decreased errors in communication of diagnosis and critical medications for secondary stroke prevention.
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Affiliation(s)
- Chloé E Hill
- Department of Neurology, University of Pennsylvania , Philadelphia, PA , USA
| | - Priya Varma
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania , Philadelphia, PA , USA
| | - David Lenrow
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania , Philadelphia, PA , USA
| | - Raymond S Price
- Department of Neurology, University of Pennsylvania , Philadelphia, PA , USA
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania , Philadelphia, PA , USA
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17
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Luger S, Hohmann C, Niemann D, Kraft P, Gunreben I, Neumann-Haefelin T, Kleinschnitz C, Steinmetz H, Foerch C, Pfeilschifter W. Adherence to oral anticoagulant therapy in secondary stroke prevention - impact of the novel oral anticoagulants. Patient Prefer Adherence 2015; 9:1695-705. [PMID: 26648702 PMCID: PMC4664488 DOI: 10.2147/ppa.s88994] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Oral anticoagulant therapy (OAT) potently prevents strokes in patients with atrial fibrillation. Vitamin K antagonists (VKA) have been the standard of care for long-term OAT for decades, but non-VKA oral anticoagulants (NOAC) have recently been approved for this indication, and raised many questions, among them their influence on medication adherence. We assessed adherence to VKA and NOAC in secondary stroke prevention. METHODS All patients treated from October 2011 to September 2012 for ischemic stroke or transient ischemic attack with a subsequent indication for OAT, at three academic hospitals were entered into a prospective registry, and baseline data and antithrombotic treatment at discharge were recorded. At the 1-year follow-up, we assessed the adherence to different OAT strategies and patients' adherence to their respective OAT. We noted OAT changes, reasons to change treatment, and factors that influence persistence to the prescribed OAT. RESULTS In patients discharged on OAT, we achieved a fatality corrected response rate of 73.3% (n=209). A total of 92% of these patients received OAT at the 1-year follow-up. We observed good adherence to both VKA and NOAC (VKA, 80.9%; NOAC, 74.8%; P=0.243) with a statistically nonsignificant tendency toward a weaker adherence to dabigatran. Disability at 1-year follow-up was an independent predictor of lower adherence to any OAT after multivariate analysis, whereas the choice of OAT did not have a relevant influence. CONCLUSION One-year adherence to OAT after stroke is strong (>90%) and patients who switch therapy most commonly switch toward another OAT. The 1-year adherence rates to VKA and NOAC in secondary stroke prevention do not differ significantly between both therapeutic strategies.
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Affiliation(s)
- Sebastian Luger
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Carina Hohmann
- Department of Neurology, Klinikum Fulda gAG, Fulda, Germany
| | - Daniela Niemann
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Peter Kraft
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Ignaz Gunreben
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | | | | | - Helmuth Steinmetz
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christian Foerch
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Waltraud Pfeilschifter
- Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
- Correspondence: Waltraud Pfeilschifter, Department of Neurology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany, Tel +49 69 6301 6395, Fax +49 69 6301 4498, Email
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