Login to MyKarger

New to MyKarger? Click here to sign up.



Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Original Paper

Adherence and Quality of Oral Anticoagulation in Cerebrovascular Disease Patients with Atrial Fibrillation

Weimar C. · Benemann J. · Katsarava Z. · Weber R. · Diener H.-C.

Author affiliations

Department of Neurology, University of Duisburg-Essen, Essen, Germany

Related Articles for ""

Eur Neurol 2008;60:142–148

Do you have an account?

Login Information





Contact Information










I have read the Karger Terms and Conditions and agree.



Login Information





Contact Information










I have read the Karger Terms and Conditions and agree.



To view the fulltext, please log in

To view the pdf, please log in

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.


Save over 20% compared to the individual article price.
Learn more

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply

Rental: USD 8.50
Cloud: USD 20.00


Select

Subscribe

  • Access to all articles of the subscribed year(s) guaranteed for 5 years
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates


Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: September 19, 2007
Accepted: February 05, 2008
Published online: July 14, 2008
Issue release date: August 2008

Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 2

ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)

For additional information: https://www.karger.com/ENE

Abstract

Background/Aims: Low rates and poor quality of oral anticoagulation (OAC) have been reported in patients with atrial fibrillation (AF). We therefore sought to investigate the prescription patterns at discharge, adherence and quality of OAC in cerebrovascular disease patients with AF. Methods: Consecutive ischemic stroke (IS) and transient ischemic attack (TIA) patients were prospectively documented in 11 German stroke centers. A central telephone follow-up after 1–2 years assessed the current antithrombotic medication and results of coagulation checks. Results: Of 1,463 surviving patients with AF, 30.5% were discharged on OAC and 13.9% on high-dose heparin. Of 329 AF patients discharged on OAC and with consent for follow-up, 88.7% of surviving patients were still on OAC at the follow-up. Of these, 52.7% reported coagulation values out of the therapeutic range during the preceding 3 months. A recurrent IS was seen in 9 patients (2.1%/year) and an intracranial hemorrhage in 2. Conclusion: We found an important underuse of OAC following TIA or IS mainly in older patients and with greater stroke-related disability. Although the reported coagulation checks showed an only moderate rate within therapeutic ranges, safety and efficacy of OAC in this cohort seem comparable to previous randomized and observational trials in AF patients.

© 2008 S. Karger AG, Basel


References

  1. Singer DE, Albers GW, Dalen JE, Go AS, Halperin JL, Manning WJ: Antithrombotic therapy in atrial fibrillation: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126 (suppl):429S–456S.
    External Resources
  2. Heeringa J, van der Kuip DA, Hofman A, Kors JA, van Herpen G, Stricker BH, et al: Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 2006;27:949–953.
  3. Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al: ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (writing committee to revise the 2001 guidelines for the management of patients with atrial fibrillation), developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006;114:e257–e354.
  4. Peterson GM, Boom K, Jackson SL, Vial JH: Doctors’ beliefs on the use of antithrombotic therapy in atrial fibrillation: identifying barriers to stroke prevention. Intern Med J 2002;32:15–23.
  5. Bungard TJ, Ghali WA, Teo KK, McAlister FA, Tsuyuki RT: Why do patients with atrial fibrillation not receive warfarin? Arch Intern Med 2000;160:41–46.
  6. Monte S, Macchia A, Pellegrini F, Romero M, Lepore V, D’Ettorre A, et al: Antithrombotic treatment is strongly underused despite reducing overall mortality among high-risk elderly patients hospitalized with atrial fibrillation. Eur Heart J 2006;27:2217–2223.
  7. Bungard TJ, Ackman ML, Ho G, Tsuyuki RT: Adequacy of anticoagulation in patients with atrial fibrillation coming to a hospital. Pharmacotherapy 2000;20:1060–1065.
  8. White HD, Gruber M, Feyzi J, Kaatz S, Tse HF, Husted S, et al: Comparison of outcomes among patients randomized to warfarin therapy according to anticoagulant control: results from SPORTIF III and V. Arch Intern Med 2007;167:239–245.
  9. Nieuwlaat R, Capucci A, Lip GY, Olsson SB, Prins MH, Nieman FH, et al: Antithrombotic treatment in real-life atrial fibrillation patients: a report from the Euro Heart Survey on Atrial Fibrillation. Eur Heart J 2006;27:3018–3026.
  10. Clinical Quality Improvement Network (CQIN) Investigators: Thromboembolic prophylaxis in 3,575 hospitalized patients with atrial fibrillation. Can J Cardiol 1998;14:695–702.
    External Resources
  11. Stafford RS, Singer DE: Recent national patterns of warfarin use in atrial fibrillation. Circulation 1998;97:1231–1233.
  12. Levy S, Maarek M, Coumel P, Guize L, Lekieffre J, Medvedowsky JL, et al: Characterization of different subsets of atrial fibrillation in general practice in France: the ALFA study. The College of French Cardiologists. Circulation 1999;99:3028–3035.
  13. Albers GW, Yim JM, Belew KM, Bittar N, Hattemer CR, Phillips BG, et al: Status of antithrombotic therapy for patients with atrial fibrillation in university hospitals. Arch Intern Med 1996;156:2311–2316.
  14. Andersen KK, Olsen TS: Reduced poststroke mortality in patients with stroke and atrial fibrillation treated with anticoagulants: results from a Danish quality-control registry of 22,179 patients with ischemic stroke. Stroke 2007;38:259–263.
  15. Tapson VF, Hyers TM, Waldo AL, Ballard DJ, Becker RC, Caprini JA, et al: Antithrombotic therapy practices in US hospitals in an era of practice guidelines. Arch Intern Med 2005;165:1458–1464.
  16. Deplanque D, Leys D, Parnetti L, Schmidt R, Ferro J, de Reuck J, et al: Secondary prevention of stroke in patients with atrial fibrillation: factors influencing the prescription of oral anticoagulation at discharge. Cerebrovasc Dis 2006;21:372–379.
  17. Goudie BM, Donnan PT, Fairfield G, Al-Agilly SS, Cachia PG: Dependency rather than old age increases the risk of warfarin-related bleeding. Br J Gen Pract 2004;54:690–692.
  18. Hamann GF, Weimar C, Glahn J, Busse O, Diener H, German Stroke Data Bank: Adherence to secondary stroke prevention strategies – results from the German Stroke Data Bank. Cerebrovasc Dis 2003;15:282–288.
  19. Tentschert S, Parigger S, Dorda V, Bittner K, Unterbuchschachner D, Greisenegger S, et al: Recurrent vascular events in patients with ischemic stroke/TIA and atrial fibrillation in relation to secondary prevention at hospital discharge. Wien Klin Wochenschr 2004;116:834–838.
  20. Samsa GP, Matchar DB, Goldstein LB, Bonito AJ, Lux LJ, Witter DM, et al: Quality of anticoagulation management among patients with atrial fibrillation: results of a review of medical records from 2 communities. Arch Intern Med 2000;160:967–973.
  21. Yousef ZR, Tandy SC, Tudor V, Jishi F, Trent RJ, Watson DK, et al: Warfarin for non-rheumatic atrial fibrillation: five year experience in a district general hospital. Heart 2004;90:1259–1262.
  22. Go A, Hylek E, Chang Y, Phillips K, Henault L, Capra A, et al: Anticoagulation therapy for stroke prevention in atrial fibrillation: how well do randomized trials translate into clinical practice? JAMA 2003;290:2685–2692.
  23. Halperin JL, Executive Steering Committee SPORTIF III and V Study Investigators: Ximelagatran compared with warfarin for prevention of thromboembolism in patients with nonvalvular atrial fibrillation: rationale, objectives, and design of a pair of clinical studies and baseline patient characteristics (SPORTIF III and V). Am Heart J 2003;146:431–438.
  24. Hart RG, Pearce LA, Rothbart RM, McAnulty JH, Asinger RW, Halperin JL: Stroke with intermittent atrial fibrillation: incidence and predictors during aspirin therapy. Stroke Prevention in Atrial Fibrillation Investigators. J Am Coll Cardiol 2000;35:183–187.
  25. Nieuwlaat R, Capucci A, Camm AJ, Olsson SB, Andresen D, Davies DW, et al: Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on Atrial Fibrillation. Eur Heart J 2005;26:2422–2434.
  26. Reynolds MW, Fahrbach K, Hauch O, Wygant G, Estok R, Cella C, et al: Warfarin anticoagulation and outcomes in patients with atrial fibrillation: a systematic review and metaanalysis. Chest 2004;126:1938–1945.
  27. Alpert JS: How can we improve our use of oral anticoagulants? Am J Med 2006;119:101–102.
  28. Kagansky N, Knobler H, Rimon E, Ozer Z, Levy S: Safety of anticoagulation therapy in well-informed older patients. Arch Intern Med 2004;164:2044–2050.
  29. Witt DM, Sadler MA, Shanahan RL, Mazzoli G, Tillman DJ: Effect of a centralized clinical pharmacy anticoagulation service on the outcomes of anticoagulation therapy. Chest 2005;127:1515–1522.
  30. European Atrial Fibrillation Trial (EAFT) Study Group: Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 1993;342:1255–1262.
  31. Bates SM, Weitz JI: The status of new anticoagulants. Br J Haematol 2006;134:3–19.
  32. Randomized evaluation of long term anticoagulant therapy (RE-LY) with dabigatran etexilate. National Library of Medicine, NCT00262600. http://clinicaltrials.gov/show/NCT00262600 (accessed December 16, 2007).
  33. Connolly S, Pogue J, Hart R, Pfeffer M, Hohnloser S, Chrolavicius S, et al: Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet 2006;367:1903–1912.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: September 19, 2007
Accepted: February 05, 2008
Published online: July 14, 2008
Issue release date: August 2008

Number of Print Pages: 7
Number of Figures: 2
Number of Tables: 2

ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)

For additional information: https://www.karger.com/ENE


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.