Published Online
on December 28, 2006

A more recent version of this article appeared on February 1, 2007

This Article Full Text (PDF) All Versions of this Article: 38/2/259    most recent 01.STR.0000254622.52483.03v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Andersen, K. K. Articles by Olsen, T. S. Search for Related Content PubMed PubMed Citation Articles by Andersen, K. K. Articles by Olsen, T. S. Pubmed/NCBI databases Medline Plus Health Information Atrial Fibrillation Blood Thinners Stroke Related Collections Secondary prevention Cerebrovascular disease/stroke Risk Factors Coumarins Arrhythmias, clinical electrophysiology, drugs Embolic stroke

Submitted on September 19, 2006
Revised on September 26, 2006
Accepted on September 29, 2006

Reduced Poststroke Mortality in Patients With Stroke and Atrial Fibrillation Treated With Anticoagulants. Results From a Danish Quality-Control Registry of 22 179 Patients With Ischemic Stroke

Klaus Kaae Andersen MS, PhD and Tom Skyhøj Olsen MD, PhD^*

From the Department of Informatics and Mathematical Modelling (K.K.A.), Section for Statistics, Technical University of Denmark, Lyngby, and the Stroke Unit (T.S.O.), Hvidovre University Hospital, Hvidovre, Denmark.

^* To whom correspondence should be addressed. E-mail: Tom.Skyhoej.Olsen{at}hh.hosp.dk.

Background and Purpose--The preventive effect of anticoagulation in patients with stroke and atrial fibrillation (AF) is documented only in trials of minor stroke. Although anticoagulation reduced stroke recurrence, those trials did not demonstrate an influence of anticoagulation on survival.

Methods--A nationwide registry that was started in 2001 with the aim of registering all hospitalized stroke patients in Denmark now includes 24 791 patients. We studied the survival of patients with ischemic stroke and AF with respect to anticoagulation treatment. All underwent an evaluation for stroke severity (according to the Scandinavian Stroke Scale), computed tomography scan, and an evaluation for cardiovascular risk factors. Follow-up duration was 4 years (mean, 1.2 years).

Results--Of all patients, 22 179 (89.4%) experienced an ischemic stroke. In total, 3670 (16.5%) had AF, and 1909 had no contraindication to anticoagulation treatment. Anticoagulation treatment was initiated in 1149 of these patients (60.2%) but omitted in 760 (39.8%) despite no contraindication to such treatment. Of the patients so treated, 18.9% died during follow-up versus 45.2% without treatment. Patients who received treatment were younger (76.7±9.5 versus 80.7±9.0 years, P<0.0001) and had less severe strokes (Scandinavian Stroke Scale score, 42.0±15.0 versus 33.6±18.2, P<0.0001). A Cox proportional-hazards model was built to study the effect of anticoagulation on survival in patients without contraindications to treatment while controlling for stroke severity, sex, and cardiovascular risk factors. Patients without anticoagulation treatment were at greater risk of dying (hazard ratio=1.91, 95% CI=1.44 to 2.52) compared with patients who received anticoagulation treatment.

Conclusions--Our data suggest that anticoagulation treatment reduces poststroke mortality in patients with ischemic stroke and AF.

Key words: anticoagulation • atrial fibrillation • prevention • prognosis • stroke

This article has been cited by other articles:

				A. J. Camm, P. Kirchhof, G. Y.H. Lip, I. Savelieva, and S. Ernst CHAPTER 29 Atrial Fibrillation ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]

				G. Stoll, C. Kleinschnitz, and B. Nieswandt Molecular mechanisms of thrombus formation in ischemic stroke: novel insights and targets for treatment Blood, November 1, 2008; 112(9): 3555 - 3562. [Abstract] [Full Text] [PDF]

				B. Wettermark, A. Persson, and M. von Euler Secondary Prevention in a Large Stroke Population: A Study of Patients' Purchase of Recommended Drugs Stroke, October 1, 2008; 39(10): 2880 - 2885. [Abstract] [Full Text] [PDF]

				H. Gulbins, I. Florath, and J. Ennker Cerebrovascular Events After Stentless Aortic Valve Replacement During a 9-Year Follow-Up Period Ann. Thorac. Surg., September 1, 2008; 86(3): 769 - 773. [Abstract] [Full Text] [PDF]

				A. Covic, P. Gusbeth-Tatomir, and D. Goldsmith Negative outcome studies in end-stage renal disease: how dark are the storm clouds? Nephrol. Dial. Transplant., January 1, 2008; 23(1): 56 - 61. [Full Text] [PDF]

				G. Tsivgoulis, S. Vassilopoulou, and K. Spengos Impact of Anticoagulation on Poststroke Mortality in Ischemic Stroke Patients With Atrial Fibrillation Stroke, July 1, 2007; 38(7): e61 - e61. [Full Text] [PDF]

				K. K. Andersen and T. S. Olsen Response to Letter by Tsivgoulis et al Stroke, July 1, 2007; 38(7): e62 - e62. [Full Text] [PDF]