Anti-clotting therapies in patients at high risk for stroke are grossly underused. A researcher speculates that physician misconceptions and poor patient education about medication to reduce the risk of atrial fibrillation underlie the problem.
"It's really a sad story," says Ying Xian, MD, PhD, of the Duke University Medical Center in Durham, NC, about research he and colleagues recently published in The JAMA Network Journals.
Their somber discovery: Out of 94,474 patients who had an acute ischemic stroke and known history of atrial fibrillation, 84% were not receiving evidence-recommended therapeutic anticoagulation therapy that could have prevented or mitigated the severity of the event.
Moreover, the researchers found that of those patients admitted to hospitals participating in the Get With the Guidelines-Stroke program:
- 30% were not receiving any antithrombotic treatment prior to stroke
- 7.6% were receiving therapeutic warfarin
- 8.8% were receiving non-vitamin K antagonist oral anticoagulants (NOACs)
- 40% were receiving antiplatelet therapy only
The most common documented reasons for no oral anticoagulation at discharge among at-risk patients included risk of bleeding (16.3%), risk of falls (10.3%), and terminal illness (6.2%).
Xian spoke with HealthLeaders about possible explanations for the two-thirds (65.8%) of patients whose records showed no documented reason to forego the therapy. The following transcript has been lightly edited.
HealthLeaders: Why do you suppose so many at-risk patients did not receive the recommended treatment?
Debra Shute is the Senior Physicians Editor for HealthLeaders Media.