Background/aims: Despite growing evidence, oral anticoagulant (OAC) use in ischaemic stroke (IS) patients with atrial fibrillation (AF) remains low globally. Identifying obstacles to OAC use could facilitate guideline-adherent treatment.
Methods: This retrospective study analysed Taiwan's National Health Insurance Research Database from 1997-2017. Consecutive patients hospitalised for acute IS between 2014 and 2017 were identified if they had pre-hospital or discharge diagnosis of AF. Patients were categorised into OAC users and OAC nonuser groups according to whether they were taking long-term OAC treatment after the index admission. Logistic regression models adjusted for demographic factors and comorbidities were used to compare the outcomes between the 2 groups.
Results: Among 24,525 IS patients with AF, 13,105 (53.4%) were OAC nonusers. Multivariable analysis showed older age, lower income, rural residence, treatment at lower-level hospitals, chronic kidney disease, coronary artery disease, heart failure, and anaemia were associated with OAC nonuse. Higher NIH Stroke Scale, CHA2DS2-VASc, and HAS-BLED scores correlated with OAC nonuse. OAC users had lower adjusted risks of all-cause mortality (HR:0.41; 95%CI:0.39-0.42) and major bleeding (HR:0.77; 95%CI:0.72-0.82).
Conclusions: OAC underutilisation in IS patients with AF was associated with sociodemographic and clinical factors. Withholding OAC correlated with adverse prognosis in these high-risk patients.