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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
Authors:Wook-Joo Kim  Jong-Moo Park  Kyusik Kang  Yong-Jin Cho  Keun-Sik Hong  Soo Joo Lee  Youngchai Ko  Kyung Bok Lee  Tai Hwan Park  Jun Lee  Jae-Kwan Cha  Dae-Hyun Kim  Kyung-Ho Yu  Byung-Chul Lee  Mi-Sun Oh  Juneyoung Lee  JiSung Lee  Myung Suk Jang  Moon-Ku Han  Hee-Joon Bae
Abstract:MethodsAIS 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.ResultsOverall, 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.ConclusionsThis study shows that antithrombotic use in AIS patients with AF might be not optimal before and after stroke in Korea.
Keywords:atrial fibrillation  drug utilization review  cerebral infarction  guideline adherence
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