Temporal Trends in Ischemic Stroke and Anticoagulation Therapy Among Medicare Patients With Atrial Fibrillation

A 15-Year Perspective (1992-2007)

JAMA: 12/24/12

A trial fibrillation (AF) is an independent, modifiable risk factor for ischemic stroke¹ and independently associated with increased mortality.² Nonvalvular AF is associated with a nearly 5-fold higher risk of ischemic stroke; this risk progressively increases with age.³ In a meta-analysis involving 29 clinical studies and 28 044 patients, judicious antithrombotic therapy with adjusted-dose warfarin was shown to reduce risk related to ischemic stroke by nearly 60% and mortality by approximately 25%, without significant increases in hemorrhagic stroke.⁴ However, diffusion of evidence-based knowledge from clinical trials into routine clinical practice demonstrates a significant time lag and evidence-to-practice gap; rates of ischemic stroke are therefore higher in clinical practice.⁵ We sought to extend previous work by Lakshminarayan et al⁶ to examine temporal trends in ischemic and hemorrhagic stroke rates and warfarin use in the Medicare population over a span of 15 years. Read more