PMID- 8996492
OWN - NLM
STAT- MEDLINE
DCOM- 19970207
LR  - 20220311
IS  - 0039-2499 (Print)
IS  - 0039-2499 (Linking)
VI  - 28
IP  - 1
DP  - 1997 Jan
TI  - Thromboembolism prophylaxis in chronic atrial fibrillation. Practice patterns in 
      community and tertiary-care hospitals.
PG  - 72-6
AB  - BACKGROUND AND PURPOSE: By 1992, several prospective trials established the 
      efficacy of anticoagulation (AC) and to some extent antiplatelet (AP) agents in 
      the prevention of stroke in the setting of atrial fibrillation (AF). The 
      objective of this study was to determine whether practice patterns in AF stroke 
      prophylaxis reflect the findings of clinical trials and whether stroke 
      prophylaxis in AF differs between community hospitals and tertiary teaching 
      hospitals. METHODS: Retrospectively, 1250 hospital charts were reviewed. After 
      patients who had undergone recent surgery, received treatment for malignancy, or 
      were not in chronic AF on discharge were eliminated, 651 remaining records were 
      analyzed for the presence of 26 clinical factors influencing the selection of 
      thromboembolism prophylaxis. Descriptive statistics and logistic regression were 
      used to analyze the association between clinical and demographic factors and the 
      decision to treat with AC, AP, or no specific antiembolic therapy. RESULTS: Of 
      the 651 patients in AF, 273 (42%) received noemboli prophylaxis while 219 (34%) 
      were treated with AC (warfarin), 146 (22%) were treated with AP, and 13 (2%) 
      received both agents. Patients discharged in AF from community hospitals were 
      significantly less likely to be treated with either AC or AP agents than patients 
      discharged from tertiary centers. A strong bias against thromboembolism 
      prophylaxis with either AC or AP agents in AF existed with age over 45 years. 
      Multivariate logistic regression indicated that the decision to treat was 
      associated only with the presence of prosthetic valve, history of prior stroke, 
      mitral disease, and absence of a recent gastrointestinal bleed or occult blood in 
      stool. Even after adjustment for these factors, a significant bias against 
      treatment with either AC or AP agents with advancing age and discharge from 
      community hospitals remained. CONCLUSIONS: Thromboembolism prophylaxis with 
      either AC or AP agents is underutilized in the setting of AF. Furthermore, 
      factors known to increase the risk of embolization in AF such as age, 
      hypertension, diabetes, and heart disease were not associated with decisions to 
      treat with either AP or AC agents. This study suggests that the use of clinical 
      guidelines suggested by trials of thromboembolism prophylaxis in AF could reduce 
      the incidence of stroke.
FAU - Munschauer, F E
AU  - Munschauer FE
AD  - Department of Neurology, Buffalo General Hospital, NY 14203, USA.
FAU - Priore, R L
AU  - Priore RL
FAU - Hens, M
AU  - Hens M
FAU - Castilone, A
AU  - Castilone A
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Stroke
JT  - Stroke
JID - 0235266
RN  - 0 (Anticoagulants)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 5Q7ZVV76EI (Warfarin)
SB  - IM
CIN - Stroke. 1997 Apr;28(4):874. PMID: 9099212
MH  - Aged
MH  - Anticoagulants/*therapeutic use
MH  - Atrial Fibrillation/classification/*drug therapy
MH  - Cerebrovascular Disorders
MH  - Contraindications
MH  - Gastrointestinal Hemorrhage
MH  - Heart Valve Prosthesis
MH  - Hospitals, Community
MH  - Hospitals, Teaching
MH  - Humans
MH  - Intracranial Embolism and Thrombosis/*prevention & control
MH  - Medical Records
MH  - Middle Aged
MH  - Mitral Valve Stenosis
MH  - Multivariate Analysis
MH  - New York
MH  - Occult Blood
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Regression Analysis
MH  - Retrospective Studies
MH  - Warfarin/*therapeutic use
EDAT- 1997/01/01 00:00
MHDA- 1997/01/01 00:01
CRDT- 1997/01/01 00:00
PHST- 1997/01/01 00:00 [pubmed]
PHST- 1997/01/01 00:01 [medline]
PHST- 1997/01/01 00:00 [entrez]
AID - 10.1161/01.str.28.1.72 [doi]
PST - ppublish
SO  - Stroke. 1997 Jan;28(1):72-6. doi: 10.1161/01.str.28.1.72.