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KMID : 1130620160120010034
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Journal of Clinical Neurology
2016 Volume.12 No. 1 p.34 ~ p.41
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Adherence to Guidelines for Antithrombotic Therapy in Patients with Atrial Fibrillation According to CHADS2 Score before and after Stroke: A Multicenter Observational Study from Korea
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Kim Wook-Joo
Park Jong-Moo
Cho Yong-Jin
Hong Keun-Sik
Lee Soo-Joo
Ko Young-Chai
Lee Kyung-Bok
Park Tai-Hwan
Lee Jun
Cha Jae-Kwan
Yu Kyung-Ho
Lee Byung-Chul
Oh Mi-Sun
Lee June-Young
Lee Ji-Sung
Jang Myung-Suk
Han Moon-Ku
Bae Hee-Joon
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Abstract
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Background and Purpose: A substantial proportion of patients with atrial fibrillation (AF) are not treated optimally; however, the inappropriateness of drug therapy has never been evaluated before or after a stroke event. We investigated the adherence to guidelines for therapy in AF patients hospitalized with acute ischemic stroke (AIS) before stroke onset and at discharge, with the aim of identifying the factors associated with inappropriate therapy.
Methods: AIS patients with AF hospitalized within 7 days of onset were identified from a prospective nine-center stroke registry database. Two cohorts were defined: patients diagnosed with AF prior to the stroke event (admission cohort) and patients diagnosed with AF at discharge from hospital (discharge cohort). Any of the following conditions were regarded as nonadherence to guidelines in this study: use of anticoagulant or nonuse of antithrombotics with CHADS2 score=0, nonuse of antithrombotics with CHADS2 score=1, or nonuse of anticoagulant with CHADS2 score ≥2.
Results: Overall, 406 patients were enrolled in the admission cohort and 518 in the discharge cohort. The rates of nonadherence before a stroke event and at discharge were 77.8% and 33.3%, respectively. These rates varied widely for both cohorts, with interhospital differences being statistically significant. Multivariable analysis revealed that old age, stroke history, and congestive heart failure were associated with nonadherence before stroke. At discharge, males, coronary heart disease, inappropriate antithrombotic use before stroke, and functional disability at discharge were associated with nonadherence.
Conclusions: This study shows that antithrombotic use in AIS patients with AF might be not optimal before and after stroke in Korea.
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KEYWORD
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atrial fibrillation, drug utilization review, cerebral infarction, guideline adhere
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