Abstract
INTRODUCTION: Untreated non-valvular atrial fibrillation is one of major causes of stroke. The goal of the study was to evaluate the use of antithrombotic medication stroke prevention and assess long-term stroke outcome.METHODS: This study involved 531 cardio embolic stroke patients of the Paul’s Stradins Clinical University Hospital, Riga, Latvia, in 2014. After discharge the patients or their relatives were interviewed by phone after 30, 90, 180, and 365 days. Standardized questions were asked about the patients’ abilities and use of prescribed secondary prevention medication. The results were compared between patient groups, assigned according to prescribed medications.RESULTS: Of all the patients included in the study, 8.9% were using oral anticoagulants before stroke onset. One year after discharge, 1.44% of patients were not using any preventive medication, 23.56% were using antiplatelet agents, 43.27% warfarin, and 31.73% target-specific oral anticoagulants. The one-year mortality rate was 40.7%. The mortality rate was significantly higher in the patient group using no secondary preventive medication or antiplatelet agents compared to the patient group that used oral anticoagulants.CONCLUSION: Cardio embolic stroke primary and secondary prevention in Latvia is lacking. The study outcomes suggest that action is needed to increase the use of oral anticoagulants in primary stroke prevention in patients with atrial fibrillation. Poor function outcomes, dementia, and patients’ incompliance limits the use of oral anticoagulants in secondary prevention.
Highlights
Untreated non-valvular atrial fibrillation is one of major causes of stroke
The study outcomes suggest that action is needed to increase the use of oral anticoagulants in primary stroke prevention in patients with atrial fibrillation
Antithrombotics use in the primary stroke prevention was found to be inappropriate
Summary
Untreated non-valvular atrial fibrillation is one of major causes of stroke. 199), “Non-valvular atrial fibrillation (AF) is the most common form of heart arrhythmias”. 199) wrote: The prevalence tends to increase with aging from 0.5% in 40-50 year old patients till 5-17% in 8085 year old patients (Camm et al, 2012; European Heart Rhythm et al, 2010; Go et al, 2001; Stewart, Hart, Hole, & McMurray, 2001). The use of oral anticoagulants decreases the risk of thromboembolic accidents in patients with non-valvular AF. To achieve effective cardio embolic accident prophylaxis, oral anticoagulants should be used regularly for prolonged period of time, which for most patients has proven to be difficult, considering the specific use of medication and possible side effects. The available oral anticoagulants in Latvia vitamin K antagonists (VKA) warfarin and target specific oral anticoagulants (TSOACs) -- rivaroxaban, dabigatran and apixaban
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