Atrial fibrillation represents one of the leading diagnoses for hospitalized patients. Patients with atrial fibrillation are five times more likely to have a stroke than those without this condition and approximately 60% of these strokes are preventable with aspirin or effective prophylactic anticoagulation. Despite the presence of well validated tools for stroke risk assessment such as CHADS2 or CHA2DS2VASc methods, current data indicates that only 5065% of eligible patients with atrial fibrillation receive either antiplatelet or anticoagulation therapy. This study assessed the rates of prophylaxis for stroke prevention in patients with atrial fibrillation upon discharge from our academic medical center.
All patients admitted between January 1, 2009 and November 16, 2011 were evaluated for the use of stroke prevention agents. A total of 11,926 patients were included. Patients who had warfarin, aspirin, dabigatran, or treatment dose lowmolecular heparin (LMWH) ordered were counted as having received stroke prevention treatment. The use of these medications within 48 h of hospital discharge was used as a proxy measure for likely continuation of the agents upon discharge. It was assumed that patients who received treatment dose LMWH were likely discharged on warfarin. Both surgical and medical patients were included in the analysis.
A breakdown of the agents used for stroke prevention in this population is noted in figure 1 and 2. Of all patients, 29% received warfarin, 18% received aspirin, 2% received dabigatran, and 5% received treatment dose LMWH while medical patient s received 28%, 16%, 1%, and 4% of these agents respectively. 47% of all patients and 52% of medical patients did not receive either antiplatelet or anticoagulation prophylaxis for stroke prevention.
Approximately 50% of hospitalized patients with atrial fibrillation were not given any agent for stroke prevention upon discharge. Although data was not stratified by CHADS2 score, those patients found to have a very low score would likely benefit by treatment with an antiplatelet agent and those with a higher score would benefit from anticoagulant treatment. In addition, those discharged on aspirin may have received under prophylaxis if their CHADS2 score warranted anticoagulation with warfarin or dabigatran. System reminders for stroke prevention assessment should be developed for all atrial fibrillation patients being discharged to home and the use of antiplatelet or anticoagulant agents should be encouraged given the effectiveness of these agents as stroke prevention strategies.
To cite this abstract:Shah H, Dyke J, Greene S. Underutilization of Anticoagulant and Antiplatelet Agents for Stroke Prevention in Atrial Fibrillation at an Academic Medical Center. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97581. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/underutilization-of-anticoagulant-and-antiplatelet-agents-for-stroke-prevention-in-atrial-fibrillation-at-an-academic-medical-center/. Accessed April 4, 2020.