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Haeusler, Karl Georg; Gerth, Andrea; Limbourg, Tobias; Tebbe, Ulrich; Oeff, Michael; Wegscheider, Karl; Treszl, András; Ravens, Ursula; Meinertz, Thomas; Kirchhof, Paulus; Breithardt, Günter; Steinbeck, Gerhard; Näbauer, Michael (2015): Use of vitamin K antagonists for secondary stroke prevention depends on the treating healthcare provider in Germany - results from the German AFNET registry. In: BMC Neurology 15:129
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Abstract

Background: Anticoagulation using vitamin K antagonists (VKAs) significantly reduces the risk of recurrent stroke in stroke patients with atrial fibrillation (AF) and is recommended by guidelines. Methods: The German Competence NETwork on Atrial Fibrillation established a nationwide prospective registry including 9, 574 AF patients, providing the opportunity to analyse AF management according to German healthcare providers. Results: On enrolment, 896 (9.4 %) patients reported a prior ischaemic stroke or transient ischaemic attack. Stroke patients were significantly older, more likely to be female, had a higher rate of cardiovascular risk factors, and more frequently received anticoagulation (almost exclusively VKA) than patients without prior stroke history. Following enrolment, 76.4 % of all stroke patients without VKA contraindications received anticoagulation, which inversely associated with age (OR 0.95 per year;95 % CI 0.92-0.97). General practitioners/internists (OR 0.40;95 % CI 0.21-0.77) and physicians working in regional hospitals (OR 0.47;95 % CI 0.29-0.77) prescribed anticoagulation for secondary stroke prevention less frequently than physicians working at university hospitals (reference) and office-based cardiologists (OR 1.40;95 % CI 0.76-2.60). The impact of the treating healthcare provider was less evident in registry patients without prior stroke. Conclusions: In the AFNET registry, anticoagulation for secondary stroke prevention was prescribed in roughly three-quarters of AF patients, a significantly higher rate than in primary prevention. We identified two factors associated with withholding oral anticoagulation in stroke survivors, namely higher age and-most prominently-treatment by a general practitioner/internist or physicians working at regional hospitals.