Introduction and Objective: Even though the introduction of less cumbersome anticoagulant agents has improved, the rates ofoverall anticoagulant treatment in eligible patients with atrial fibrillation (AF) remain to be defined. We aimed to assess the rates of and determinants for the use of anticoagulation treatment before stroke in patients with known AF since the introduction of direct oral anticoagulants (DOAC) in clinical practice. Methods: Consecutive patients admitted to an individual stroke unit, from September 2013 through July 2019, for acute ischemic stroke or transient ischemic attack (TIA) with known AF before the event were included in the study. Logistic regression analysis was used to identify independent predictors of the use of anticoagulant treatment. Results: Overall, 155 patients with ischemic stroke/TIA and known AF were included in this study. Among 152 patients with a CHA₂DS₂-VASc score #x3e;1, 43 patients were not receiving any treatment, 47 patients were receiving antiplatelet agents, and the remaining 62 patients were on oral anticoagulants. Among 34 patients on DOAC, 13 were receiving a nonlabeled reduced dose and 18 out of 34 patients on vitamin K antagonists had an INR value #x3c;2 at the time of admission. Before stroke, only 34 out of 155 patients (21.9%) were adequately treated according to current guidelines. Previous stroke/TIA was the only independent predictor of the use of anticoagulant therapy. Conclusions: Only 21.9% of the patients hospitalized for a stroke or TIA with known AF before the event were adequately treated according to recent treatment guidelines. It is important to improve medical information about the risk of AF and the efficacy of anticoagulants in stroke prevention.
Cerebrovasc Dis Extra 2020;10:44–49

中文翻译：

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已知房颤患者卒中前抗凝治疗的使用率和决定因素。

引言和目的：尽管减少了繁琐的抗凝剂的引入，但其使用率仍然很高。合格房颤（AF）患者的总体抗凝治疗仍有待确定。自临床实践中引入直接口服抗凝剂（DOAC）以来，我们旨在评估已知房颤患者卒中前抗凝治疗的使用率和决定因素。方法：本研究纳入了2013年9月至2019年7月因急性AF或已知房颤而发生短暂性脑缺血发作（TIA）的个体卒中患者。使用逻辑回归分析来确定抗凝治疗的独立预测因素。结果：本研究共纳入155例缺血性卒中/ TIA和已知房颤患者。在152例CHA患者中₂ DS ₂ -VASc得分＃x3e; 1，43位患者未接受任何治疗，47位患者正在接受抗血小板药物，其余62位患者正在接受口服抗凝剂治疗。在接受DOAC的34例患者中，有13例接受了未标记的减量剂量，而在接受维生素K拮抗剂的34例患者中，有18例在入院时INR值为＃x3c; 2。中风前，根据目前的指南，在155例患者中，只有34例（21.9％）得到了适当的治疗。既往卒中/ TIA是使用抗凝治疗的唯一独立预测指标。结论：根据最近的治疗指南，在事件发生前因中风或TIA住院的中风或TIA住院患者中，只有21.9％得到了充分治疗。重要的是要改善有关房颤风险和抗凝药在中风预防中的功效的医学信息。
Cerebrovasc Dis Extra 2020; 10：44–49