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Bleeding risk, physical functioning and non-use of anticoagulation

Post-stroke anticoagulation decisions are made based on clinical factors associated with bleed risk and motor deficits or physical functioning. However, opportunities may exist for improving clinician documentation of specific reasoning for non-anticoagulation prescription, according to a study published recently in the Quarterly Journal of Medicine.1

This is a secondary analysis of a retrospective cohort study conducted in the US of data retrieved via medical records, including National Institutes of Health Stroke Scale score, Functional Independence Measure (FIM) motor score (motor or physical function), ambulation on second day of hospitalisation, Morse Falls Scale (fall risk) and HAS-BLED score (Hypertension; Abnormal renal and liver function; Stroke; Bleeding; Labile INRs; Elderly >65; and Drugs or alcohol). Data analyses included bivariate comparisons between people with and without anticoagulation at discharge. Logistic-regression modelling was used to assess predictors of discharge anticoagulation.

There were 334 subjects included in the analyses, whose average age was 75 years old. Anticoagulation was prescribed at discharge for 235 (70%) of patients. In the adjusted regression analyses, only the FIM motor score (adjusted OR = 1.015, 95% CI 1.001–1.028) and the HAS-BLED score (adjusted OR = 0.36, 95% CI 0.22–0.58) were significantly associated with anticoagulation prescription at discharge.

References

1. Schmid AA, Ofner S, Shorr RI, Williams LS, Bravata DM. Bleeding risk, physical functioning and non-use of anticoagulation among patients with stroke and atrial fibrillation. QJM 2015. http://dx.doi.org/10.1093/qjmed/hcu176

Published on: April 29, 2015

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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