A424 JACC April 1, 2014 Volume 63, Issue 12 Arrhythmias and Clinical EP LACK OF ANTICOAGULATION IS COMMON IN PATIENTS WITH ATRIAL FIBRILLATION WHO DEVELOP AN ISCHEMIC STROKE OR TRANSIENT ISCHEMIC ATTACK: THE FIBSTROKE STUDY Poster Contributions Hall C Sunday, March 30, 2014, 3:45 p.m.-4:30 p.m. Session Title: Arrhythmias and Clinical EP: New Observations Affecting Clinical Management Abstract Category: 4. Arrhythmias and Clinical EP: AF/SVT Presentation Number: 1217-111 Authors: Antti Palomaki, Pirjo Mustonen, Tuija Vasankari, Ilpo Nuotio, Antti Ylitalo, Jussi Jaakkola, Riho Luite, Paivi Hartikainen, Juha Hartikainen, Juhani Airaksinen, Keski-Suomi Central Hospital, Jyvaskyla, Finland, Turku University Hospital, Turku, Finland Background: Lack of anticoagulation is a major risk for embolic events in patients with atrial ﬁbrillation (AF). Methods: In this retrospective study we analyzed data from 1,066 patients with previously diagnosed AF who suffered a total of 1,027 ischemic strokes and 260 transient ischemic attacks (TIA) during 2003-2012. Results: In 92.2% (n=1186) of the events CHA2DS2VASc score of the patient was ≥ 2 and would have been an indication for anticoagulation according to the current guidelines. In 53.3% of these 1186 events the patient was using anticoagulation before the onset of stroke. Patients with paroxysmal AF, HASBLED score ≥3, alcohol abuse or previous bleeding were using anticoagulation less often than patients without these characteristics (Table). There was a signiﬁcant (p<0.001) increase in the use of anticoagulation during the study period from 41.4% at 2003 to 65.8% at 2012. The mean delay between the diagnosis of AF and stroke or TIA was 4.4 years (median 3.6 years). Conclusion: Lack of anticoagulation is still common in AF patients who develop a stroke or TIA. Especially patients with paroxysmal AF, high estimated bleeding risk, previous bleeding or alcohol abuse seem to have a high risk for not receiving anticoagulation. Anticoagulation in patients with previously diagnosed AF and CHA2DS2VASc ≥ 2 Receiving anticoagulation before the onset of stroke n (%) p Paroxysmal AF 151/401 (37.7) Chronic AF 391/596 (65.6) <.001 HASBLED≥3 267/577 (46.3) HASBLED<3 365/609 (59.9) <.001 Alcohol abuse 9/42 (21.4) No alcohol abuse 621/1139 (54.5) <.001 Previous bleed 24/86 (27.9) No previous bleed 602/1092 (55.1) <.001 No previous stroke or TIA 360/777 (46.3) Previous stroke or TIA 269/400 (67.3) <.001 Women 353/693 (50.9) Men 279/493 (56.6) .059

LACK OF ANTICOAGULATION IS COMMON IN PATIENTS WITH ATRIAL FIBRILLATION WHO DEVELOP AN ISCHEMIC STROKE OR TRANSIENT ISCHEMIC ATTACK: THE FIBSTROKE STUDY

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Page 1: LACK OF ANTICOAGULATION IS COMMON IN PATIENTS WITH ATRIAL FIBRILLATION WHO DEVELOP AN ISCHEMIC STROKE OR TRANSIENT ISCHEMIC ATTACK: THE FIBSTROKE STUDY

A424JACC April 1, 2014

Volume 63, Issue 12

Arrhythmias and Clinical EP

Lack of anticoaguLation is common in patiEnts with atriaL fibriLLation who dEVELop an ischEmic strokE or transiEnt ischEmic attack: thE fibstrokE study

Poster ContributionsHall CSunday, March 30, 2014, 3:45 p.m.-4:30 p.m.

Session Title: Arrhythmias and Clinical EP: New Observations Affecting Clinical ManagementAbstract Category: 4. Arrhythmias and Clinical EP: AF/SVTPresentation Number: 1217-111

Authors: Antti Palomaki, Pirjo Mustonen, Tuija Vasankari, Ilpo Nuotio, Antti Ylitalo, Jussi Jaakkola, Riho Luite, Paivi Hartikainen, Juha Hartikainen, Juhani Airaksinen, Keski-Suomi Central Hospital, Jyvaskyla, Finland, Turku University Hospital, Turku, Finland

background: Lack of anticoagulation is a major risk for embolic events in patients with atrial fibrillation (AF).

methods: In this retrospective study we analyzed data from 1,066 patients with previously diagnosed AF who suffered a total of 1,027 ischemic strokes and 260 transient ischemic attacks (TIA) during 2003-2012.

results: In 92.2% (n=1186) of the events CHA2DS2VASc score of the patient was ≥ 2 and would have been an indication for anticoagulation according to the current guidelines. In 53.3% of these 1186 events the patient was using anticoagulation before the onset of stroke. Patients with paroxysmal AF, HASBLED score ≥3, alcohol abuse or previous bleeding were using anticoagulation less often than patients without these characteristics (Table). There was a significant (p<0.001) increase in the use of anticoagulation during the study period from 41.4% at 2003 to 65.8% at 2012. The mean delay between the diagnosis of AF and stroke or TIA was 4.4 years (median 3.6 years).

conclusion: Lack of anticoagulation is still common in AF patients who develop a stroke or TIA. Especially patients with paroxysmal AF, high estimated bleeding risk, previous bleeding or alcohol abuse seem to have a high risk for not receiving anticoagulation.

Anticoagulation in patients with previously diagnosed AF and CHA2DS2VASc ≥ 2Receiving anticoagulation before the onset of stroke n (%)

Paroxysmal AF151/401 (37.7)

Chronic AF391/596 (65.6)

<.001

HASBLED≥3267/577 (46.3)

HASBLED<3365/609 (59.9)

<.001

Alcohol abuse9/42 (21.4)

No alcohol abuse621/1139 (54.5)

<.001

Previous bleed24/86 (27.9)

No previous bleed602/1092 (55.1)