Associations with anticoagulation: a cross-sectional registry-based analysis of stroke survivors with atrial fibrillation

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 (CHA(2)DS(2)-VAS(C) 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 CHA(2)DS(2)-VAS(C) score was 5 (IQR 4-6). VKA was prescribed in 1165 (34%). On univariate analysis, higher CHA(2)DS(2)-VAS(C) 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.