Low Use of Oral Anticoagulant Prescribing for Secondary Stroke Prevention
Results From the Ontario Stroke Registry
Bibliographic Data
| ID | 9101666 |
|---|---|
| Authors | Reema Shah (0000-0002-3350-6206, McMaster University, corresponding author), Shudong Li (0000-0001-6347-9539, Institute for Clinical Evaluative Sciences), Melissa Stamplecoski (Institute for Clinical Evaluative Sciences), Moira K Kapral (0000-0002-3444-9928, Institute for Clinical Evaluative Sciences) |
| Year | 2016 |
| Volume | 54 |
| Issue | 10 |
| Pages | 907-912 |
| Publication date | 2016-10-01 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0000000000000589 |
| PMID | 27367867 |
| OpenAlex | W2461800645 |
| Language | EN |
| References cited | 50 |
BACKGROUND: Oral anticoagulation reduces the risk of stroke in atrial fibrillation but is often underused. OBJECTIVES: To identify factors associated with oral anticoagulant prescribing and adherence after stroke or transient ischemic attack (TIA). RESEARCH DESIGN: Retrospective cohort study using linked Ontario Stroke Registry and prescription claims data. SUBJECTS: Consecutive patients with atrial fibrillation and ischemic stroke/TIA admitted to 11 stroke centers in Ontario, Canada between 2003 and 2011. MEASURES: We used modified Poisson regression models to determine predictors of anticoagulant prescribing and multiple logistic regression to determine predictors of 1-year adherence. RESULTS: Of the 5781 patients in the study cohort, 4235 (73%) were prescribed oral anticoagulants at discharge. Older patients were less likely to receive anticoagulation [adjusted relative risk (aRR) for each additional year=0.997; 95% confidence interval (CI), 0.995-0.998], as were those with TIA compared with ischemic stroke (aRR=0.904; 95% CI, 0.865-0.945), prior gastrointestinal bleed (aRR=0.778; 95% CI, 0.693-0.873), dementia (aRR=0.912; 95% CI, 0.856-0.973), and those from a long-term care facility (aRR=0.810; 95% CI, 0.737-0.891). After limiting the sample to those without obvious contraindications to anticoagulation, age, dementia, and long-term care residence continued to be associated with lower prescription of oral anticoagulants. One-year adherence to therapy was similar across most patient groups. CONCLUSIONS: Age, dementia, and long-term care residence are predictors of lower oral anticoagulant use for secondary stroke prevention and represent key target areas for quality improvement initiatives
Anticoagulant · Atrial fibrillation · Cohort · Cohort study · Confidence interval · Dementia · Disease · Logistic regression · Medical prescription · Poisson regression · Population · Relative risk · Retrospective cohort study · Stroke (engine) · Acute Ischemic Stroke Management · Atrial Fibrillation Management and Outcomes · Emergency Medicine · Internal Medicine · Intracerebral and Subarachnoid Hemorrhage Research · Medicine · Pediatrics
| Citation velocity | historical |
|---|---|
| Highly cited | No |