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학술저널
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대한신경과학회 Journal of Clinical Neurology Journal of Clinical Neurology 제12권 제1호
발행연도
2016.1
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34 - 41 (8page)

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Background and Purpose A substantial proportion of patients with atrial fbrillation (AF) are not treated optimally; however, the inappropriateness of drug therapy has never been evaluated before or afer a stroke event. We investigated the adherence to guidelines for therapy in AF patients hospitalized with acute ischemic stroke (AIS) before stroke onset and at discharge, with the aim of identifying the factors associated with inappropriate therapy. Methods AIS patients with AF hospitalized within 7 days of onset were identifed from a prospective nine-center stroke registry database. Two cohorts were defned: patients diagnosed with AF prior to the stroke event (admission cohort) and patients diagnosed with AF at discharge from hospital (discharge cohort). Any of the following conditions were regarded as nonadherence to guidelines in this study: use of anticoagulant or nonuse of antithrombotics with CHADS2 score=0, nonuse of antithrombotics with CHADS2 score=1, or nonuse of anticoagulant with CHADS2 score ≥2. Results Overall, 406 patients were enrolled in the admission cohort and 518 in the discharge cohort. Te rates of nonadherence before a stroke event and at discharge were 77.8% and 33.3%, respectively. Tese rates varied widely for both cohorts, with interhospital diferences being statistically signifcant. Multivariable analysis revealed that old age, stroke history, and congestive heart failure were associated with nonadherence before stroke. At discharge, males, coronary heart disease, inappropriate antithrombotic use before stroke, and functional disability at discharge were associated with nonadherence. Conclusions Tis study shows that antithrombotic use in AIS patients with AF might be not optimal before and afer stroke in Korea.
#atrial fbrillation #drug utilization review #cerebral infarction #guideline adherence

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참고문헌 (30)

참고문헌 신청
Lip GY / 2010 / Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation / Chest 137:263~272 google schola Singer DE / 2008 / Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) / Chest 133(6 Suppl):546S~592S google schola Fuster V / 2006 / ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society / Circulation 114:e257~e354 google schola Clinical Research Center for Stroke / Clinical Practice Guidelines for Stroke. Revision / Clinical Research Center for Stroke google schola Goldstein LB / 2011 / Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association / Stroke 42:517~584 google schola

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