Abstract Details

Title Factors Associated with Oral Anticoagulant Non-use in Patients with Atrial Fibrillation-related Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S53 - Stroke Prevention (3:42 PM-3:54 PM)

Poster/Presentation
Number 002

Objective We identified pre-admission oral anticoagulant (OAC) utilization patterns and factors predictive of OAC non-use in patients hospitalized for stroke due to atrial fibrillation (AF).

Background OACs are highly effective for stroke prevention in atrial fibrillation (AF), yet they are largely underutilized in clinical practice. Factors related to OAC non-use for patients with known AF are not well described.

Design/Methods

We included 22,220 patients with ischemic stroke due to previously diagnosed AF enrolled in the Florida Stroke Registry from 2010-2017. A multivariable-adjusted logistic regression model was used to identify factors associated with pre-stroke OAC non-use for patients with AF-related stroke.

Results

A total of 16,246 (73%) patients with AF-related stroke were not on OAC pre-stroke. Compared to patients on OAC, non-OAC patients were more likely to be ≥80 years old, have Medicaid/no insurance, lower CHA₂DS₂-VASc scores and greater stroke severity at presentation. After adjustment for age, sex, race-ethnicity, insurance status and vascular risk factors, baseline OAC non-use was higher for patients with Medicaid/no insurance (vs. private insurance, (OR 1.34 [95% CI 1.08-1.67]), smokers (OR 1.29 [1.09-1.52] and patients with NIHSS ≥6 (vs. NIHSS≤5, OR 1.18 [1.11-1.26]). A trend towards greater odds of OAC non-use was seen in women (vs. men, OR 1.07 [0.99-1.14, P=0.07]).

Conclusions The majority of AF-related stroke patients with known AF were not anticoagulated prior to hospitalization for stroke in our study. Insurance status and smoking status had the greatest influence on pre-stroke OAC use. Anticoagulated patients had lower stroke severity on admission. Further efforts are needed to increase OAC use to reduce the burden of stroke for patients with AF, especially for vulnerable populations.

Authors/Disclosures
Nicole B. Sur, MD (University of Miami) PRESENTER	Dr. Sur has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke. The institution of Dr. Sur has received research support from Florida Stroke Registry. The institution of Dr. Sur has received research support from Miami CTSI & NIH/NINDS.
Sebastian Koch, MD (University of Miami)	Dr. Koch has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Multiple Legal Matters. Dr. Koch has received stock or an ownership interest from Cerepeutics. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
Marco R. Di Tullio, MD (Div of Cardiology)	No disclosure on file
	No disclosure on file
	No disclosure on file
Hannah Gardener, ScD (University of Miami)	Ms. Gardener has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Intersocietal Accreditation Commission. Ms. Gardener has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ellipse Analytics. Ms. Gardener has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Baum Hedlund. Ms. Gardener has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant with A Green Slate Consulting.
	No disclosure on file
	No disclosure on file
William S. Burgin, MD	Dr. Burgin has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for VuEssence. Dr. Burgin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Burgin has stock in VuEssence. The institution of Dr. Burgin has received research support from VuEssence. The institution of Dr. Burgin has received research support from Bristol-Myers Squibb. The institution of Dr. Burgin has received research support from ReNeuron.
David Z. Rose, MD (USF)	Dr. Rose has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Boston Scientific. Dr. Rose has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Chiesi USA. Dr. Rose has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Medtronic. Dr. Rose has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Boehringer Ingelheim . Dr. Rose has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for CSL-Behring .
	No disclosure on file
Jose G. Romano, MD, FAAN (University of Miami, Miller School of Medicine)	Dr. Romano has stock in Vycor Medical/NovaVision. The institution of Dr. Romano has received research support from NIH/NINDS. The institution of Dr. Romano has received research support from NIH/NHLBI.
Ralph L. Sacco, MD, MS, FAHA	Dr. Sacco has received personal compensation in the range of $100,000-$499,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Sacco has received research support from NIH, NINDS, NCATS, NIMHD. The institution of Dr. Sacco has received research support from FL Department of Health. Dr. Sacco has received research support from University of Washington, Seattle. Dr. Sacco has received publishing royalties from a publication relating to health care.
Tatjana Rundek, MD, PhD	The institution of Dr. Rundek has received research support from NIH.

��ɫ��

��ɫ��