Author(s): AbdulRahim AH, Wong J, McAlpine C, Young C, Quinn TJ
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Abstract OBJECTIVE: To describe vitamin K antagonist (VKA) anticoagulation prescribing patterns in stroke survivors with atrial fibrillation (AF), with particular emphasis on sociodemographic associations with VKA prescription. METHODS: We conducted a cross-sectional analysis of city-wide Glasgow primary care data held as part of the Local Enhanced Services (LES) for the year 2010. We collated clinical and sociodemographic data of community-dwelling ischaemic stroke survivors with AF, including risk factors; comorbidity; socioeconomic status and prescribing. We described stroke risk and bleeding risk using recommended stratification tools (CHA2DS2-VASC and HAS-BLED). Univariate and multivariate associations with anticoagulant prescription were described by ORs and corresponding 95\% CI. RESULTS: We identified 3429 community-dwelling, ischaemic stroke survivors with AF; median age 78 (IQR 72-84); 1699 (49\%) male. Median CHA2DS2-VASC score was 5 (IQR 4-6). VKA was prescribed in 1165 (34\%). On univariate analysis, higher CHA2DS2-VASC was associated with fewer VKA prescriptions (OR 0.90, 95\% CI 0.45 to 0.95). On multivariate analysis, older age (OR 0.97, 95\% CI 0.96 to 0.98) and higher deprivation scores (OR 0.59, 95\% CI 0.57 to 0.76) were independently associated with non-prescription of VKA. CONCLUSIONS: Anticoagulation was underused in this high-risk population, and those at highest risk were less likely to be treated. Strategies need to be developed to improve prescription of anticoagulation treatment.
This article was published in Heart
and referenced in Evidence based Medicine and Practice