PMID- 25966900
OWN - NLM
STAT- MEDLINE
DCOM- 20160316
LR  - 20220317
IS  - 1421-9786 (Electronic)
IS  - 1015-9770 (Linking)
VI  - 39
IP  - 5-6
DP  - 2015
TI  - Cognitive impairment is not a predictor of failure to adhere to anticoagulation 
      of stroke patients with atrial fibrillation.
PG  - 325-31
LID - 10.1159/000381728 [doi]
AB  - BACKGROUND: Oral anticoagulation (OAC) with vitamin K antagonists (VKA) or direct 
      oral anticoagulants (DOAC) is an effective strategy that is used for stroke 
      prevention in patients with atrial fibrillation (AF). However, OAC is underused 
      particularly in elderly patients, who are often physically disabled or 
      cognitively impaired. We aimed at evaluating the effect of cognitive status and 
      disability on OAC adherence 1 year after stroke or TIA. METHODS: In this 
      prospective, single-center, observational study patients with ischemic stroke or 
      TIA were consecutively included between 3/2011 and 9/2012. The detailed medical 
      history, basic demographic variables, cardiovascular risk factors, stroke 
      severity according to the National Institutes of Health Stroke Scale (NIHSS), 
      medication including OAC were all recorded. Cognitive performance was measured 
      using the Montreal Cognitive Assessment (MoCA) score at baseline. The functional 
      status was assessed by recording activities and instrumental activities of daily 
      living, respectively (ADL, IADL). After 12 months, patients had a follow-up visit 
      to reassess the cognitive and functional status (MoCA, ADL and IADL) and to 
      document the current use of OAC. RESULTS: In total, 12 months after the ischemic 
      stroke or TIA AF had been diagnosed in 160/586 (27.3%). Of these, 151 patients 
      (94.4%) were treated with OAC. OAC was performed using VKA in 79/151 (52.3%) and 
      DOACs in 72/151 (47.7%). Cognitive impairment at 12 months follow-up was not 
      associated with the absence of OAC treatment. However, regression analysis 
      revealed that patients with AF with physical (ADL) and functional disability 
      (IADL) were less likely to be treated with OAC (p = 0.08 and p = 0.04, 
      respectively) 12 months after a stroke. None of these two factors, however, was 
      independently associated with nonadherence to OAC 12 months after stroke. 
      Although cognitive performance was similar in patients receiving VKA and direct 
      anticoagulants (DOAC), adherence to VKA tended to be lower (82.6 vs. 94.6%, p = 
      0.12). CONCLUSIONS: In stroke and TIA patients with AF, the multifactorial 
      medical and functional constellation rather than cognitive impairment 
      specifically can be an obstacle for long-term OAC.
CI  - (c) 2015 S. Karger AG, Basel.
FAU - Horstmann, Solveig
AU  - Horstmann S
AD  - Department of Neurology, University of Heidelberg, Heidelberg, Germany.
FAU - Rizos, Timolaos
AU  - Rizos T
FAU - Saribas, Michaela
AU  - Saribas M
FAU - Efthymiou, Evdokia
AU  - Efthymiou E
FAU - Rauch, Geraldine
AU  - Rauch G
FAU - Veltkamp, Roland
AU  - Veltkamp R
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150507
PL  - Switzerland
TA  - Cerebrovasc Dis
JT  - Cerebrovascular diseases (Basel, Switzerland)
JID - 9100851
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
SB  - IM
MH  - Aged
MH  - Anticoagulants/*therapeutic use
MH  - Atrial Fibrillation/*complications/diagnosis
MH  - Cognition Disorders/*complications
MH  - Female
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Humans
MH  - Male
MH  - Prospective Studies
MH  - Risk Factors
MH  - Stroke/complications/*drug therapy
EDAT- 2015/05/15 06:00
MHDA- 2016/03/17 06:00
CRDT- 2015/05/14 06:00
PHST- 2015/01/12 00:00 [received]
PHST- 2015/03/16 00:00 [accepted]
PHST- 2015/05/14 06:00 [entrez]
PHST- 2015/05/15 06:00 [pubmed]
PHST- 2016/03/17 06:00 [medline]
AID - 000381728 [pii]
AID - 10.1159/000381728 [doi]
PST - ppublish
SO  - Cerebrovasc Dis. 2015;39(5-6):325-31. doi: 10.1159/000381728. Epub 2015 May 7.