Disparities and Temporal Trends in the Use of Anticoagulation in Patients With Ischemic Stroke and Atrial Fibrillation

Nicole B. Sur, Kefeng Wang, Marco R. Di Tullio, Carolina M. Gutierrez, Chuanhui Dong, Sebastian Koch, Hannah Gardener, Enid J. García-Rivera, Juan Carlos Zevallos, W. Scott Burgin, David Z. Rose, Jeffrey J. Goldberger, Jose G. Romano, Ralph L. Sacco, Tatjana Rundek

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background and Purpose- Ischemic stroke (IS) secondary to atrial fibrillation (AF) is largely preventable with the use of anticoagulation. We sought to identify race-ethnicity and sex disparities with the use of direct oral anticoagulants (DOACs), aspirin, and warfarin in IS patients with AF and to identify temporal trends in the utilization of these medications. Methods- The FLiPER-AF Stroke Study (Florida Puerto Rico Atrial Fibrillation) included 24 040 IS cases enrolled in the Florida-Puerto Rico Collaboration to Reduce Stroke Registry from 2010 to 2016. Multivariable logistic regression models were performed to evaluate the effect of race-ethnicity and sex on utilization of DOACs, aspirin, and warfarin for stroke prevention in AF after adjustment for sociodemographic, hospital, and clinical factors. Results- Among 24 040 IS cases, 54% were women and 10% black, 12% FL-Hispanics, 4% PR-Hispanic, and 74% whites. From 2010 to 2016, DOAC use increased from 0% to 36%, warfarin use decreased from 51% to 17%, and aspirin use remained relatively stable (42%-40%). After adjustment, blacks had higher odds of warfarin (odds ratio, 1.22; 95% CI, 1.07-1.40) prescription at discharge compared with whites. Men had higher rates of aspirin (42.1% versus 38.8%), warfarin (33.6% versus 28.9%), and DOAC (21.3% versus 19.3%) use compared with women. After adjustment, women had lower odds of being discharged on aspirin (odds ratio, 0.92; 95% CI, 0.86-0.98) or warfarin (odds ratio, 0.91; 95% CI, 0.84-0.99). There was no sex difference in use of DOACs. Conclusions- Our study confirmed the increasing use of DOACs, downtrending use of warfarin, whereas aspirin use remained similar over the years. There are sex and race-ethnicity disparities in anticoagulation use in IS patients with AF. It is critical to understand underlying drivers of these disparities to develop better practice strategies for stroke prevention in patients with AF. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT03627806.

Original languageEnglish (US)
Pages (from-to)1452-1459
Number of pages8
JournalStroke
Volume50
Issue number6
DOIs
StatePublished - Jun 1 2019

Fingerprint

Atrial Fibrillation
Warfarin
Stroke
Anticoagulants
Aspirin
Puerto Rico
Odds Ratio
Hispanic Americans
Logistic Models
Sex Characteristics
Prescriptions
Registries
Clinical Trials

Keywords

  • atrial fibrillation
  • cerebrovascular disorders
  • humans
  • warfarin
  • women

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Disparities and Temporal Trends in the Use of Anticoagulation in Patients With Ischemic Stroke and Atrial Fibrillation. / Sur, Nicole B.; Wang, Kefeng; Di Tullio, Marco R.; Gutierrez, Carolina M.; Dong, Chuanhui; Koch, Sebastian; Gardener, Hannah; García-Rivera, Enid J.; Zevallos, Juan Carlos; Burgin, W. Scott; Rose, David Z.; Goldberger, Jeffrey J.; Romano, Jose G.; Sacco, Ralph L.; Rundek, Tatjana.

In: Stroke, Vol. 50, No. 6, 01.06.2019, p. 1452-1459.

Research output: Contribution to journalArticle

Sur, NB, Wang, K, Di Tullio, MR, Gutierrez, CM, Dong, C, Koch, S, Gardener, H, García-Rivera, EJ, Zevallos, JC, Burgin, WS, Rose, DZ, Goldberger, JJ, Romano, JG, Sacco, RL & Rundek, T 2019, 'Disparities and Temporal Trends in the Use of Anticoagulation in Patients With Ischemic Stroke and Atrial Fibrillation', Stroke, vol. 50, no. 6, pp. 1452-1459. https://doi.org/10.1161/STROKEAHA.118.023959
Sur, Nicole B. ; Wang, Kefeng ; Di Tullio, Marco R. ; Gutierrez, Carolina M. ; Dong, Chuanhui ; Koch, Sebastian ; Gardener, Hannah ; García-Rivera, Enid J. ; Zevallos, Juan Carlos ; Burgin, W. Scott ; Rose, David Z. ; Goldberger, Jeffrey J. ; Romano, Jose G. ; Sacco, Ralph L. ; Rundek, Tatjana. / Disparities and Temporal Trends in the Use of Anticoagulation in Patients With Ischemic Stroke and Atrial Fibrillation. In: Stroke. 2019 ; Vol. 50, No. 6. pp. 1452-1459.
@article{c0080181dc8a452392036518bf810008,
title = "Disparities and Temporal Trends in the Use of Anticoagulation in Patients With Ischemic Stroke and Atrial Fibrillation",
abstract = "Background and Purpose- Ischemic stroke (IS) secondary to atrial fibrillation (AF) is largely preventable with the use of anticoagulation. We sought to identify race-ethnicity and sex disparities with the use of direct oral anticoagulants (DOACs), aspirin, and warfarin in IS patients with AF and to identify temporal trends in the utilization of these medications. Methods- The FLiPER-AF Stroke Study (Florida Puerto Rico Atrial Fibrillation) included 24 040 IS cases enrolled in the Florida-Puerto Rico Collaboration to Reduce Stroke Registry from 2010 to 2016. Multivariable logistic regression models were performed to evaluate the effect of race-ethnicity and sex on utilization of DOACs, aspirin, and warfarin for stroke prevention in AF after adjustment for sociodemographic, hospital, and clinical factors. Results- Among 24 040 IS cases, 54{\%} were women and 10{\%} black, 12{\%} FL-Hispanics, 4{\%} PR-Hispanic, and 74{\%} whites. From 2010 to 2016, DOAC use increased from 0{\%} to 36{\%}, warfarin use decreased from 51{\%} to 17{\%}, and aspirin use remained relatively stable (42{\%}-40{\%}). After adjustment, blacks had higher odds of warfarin (odds ratio, 1.22; 95{\%} CI, 1.07-1.40) prescription at discharge compared with whites. Men had higher rates of aspirin (42.1{\%} versus 38.8{\%}), warfarin (33.6{\%} versus 28.9{\%}), and DOAC (21.3{\%} versus 19.3{\%}) use compared with women. After adjustment, women had lower odds of being discharged on aspirin (odds ratio, 0.92; 95{\%} CI, 0.86-0.98) or warfarin (odds ratio, 0.91; 95{\%} CI, 0.84-0.99). There was no sex difference in use of DOACs. Conclusions- Our study confirmed the increasing use of DOACs, downtrending use of warfarin, whereas aspirin use remained similar over the years. There are sex and race-ethnicity disparities in anticoagulation use in IS patients with AF. It is critical to understand underlying drivers of these disparities to develop better practice strategies for stroke prevention in patients with AF. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT03627806.",
keywords = "atrial fibrillation, cerebrovascular disorders, humans, warfarin, women",
author = "Sur, {Nicole B.} and Kefeng Wang and {Di Tullio}, {Marco R.} and Gutierrez, {Carolina M.} and Chuanhui Dong and Sebastian Koch and Hannah Gardener and Garc{\'i}a-Rivera, {Enid J.} and Zevallos, {Juan Carlos} and Burgin, {W. Scott} and Rose, {David Z.} and Goldberger, {Jeffrey J.} and Romano, {Jose G.} and Sacco, {Ralph L.} and Tatjana Rundek",
year = "2019",
month = "6",
day = "1",
doi = "10.1161/STROKEAHA.118.023959",
language = "English (US)",
volume = "50",
pages = "1452--1459",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Disparities and Temporal Trends in the Use of Anticoagulation in Patients With Ischemic Stroke and Atrial Fibrillation

AU - Sur, Nicole B.

AU - Wang, Kefeng

AU - Di Tullio, Marco R.

AU - Gutierrez, Carolina M.

AU - Dong, Chuanhui

AU - Koch, Sebastian

AU - Gardener, Hannah

AU - García-Rivera, Enid J.

AU - Zevallos, Juan Carlos

AU - Burgin, W. Scott

AU - Rose, David Z.

AU - Goldberger, Jeffrey J.

AU - Romano, Jose G.

AU - Sacco, Ralph L.

AU - Rundek, Tatjana

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Background and Purpose- Ischemic stroke (IS) secondary to atrial fibrillation (AF) is largely preventable with the use of anticoagulation. We sought to identify race-ethnicity and sex disparities with the use of direct oral anticoagulants (DOACs), aspirin, and warfarin in IS patients with AF and to identify temporal trends in the utilization of these medications. Methods- The FLiPER-AF Stroke Study (Florida Puerto Rico Atrial Fibrillation) included 24 040 IS cases enrolled in the Florida-Puerto Rico Collaboration to Reduce Stroke Registry from 2010 to 2016. Multivariable logistic regression models were performed to evaluate the effect of race-ethnicity and sex on utilization of DOACs, aspirin, and warfarin for stroke prevention in AF after adjustment for sociodemographic, hospital, and clinical factors. Results- Among 24 040 IS cases, 54% were women and 10% black, 12% FL-Hispanics, 4% PR-Hispanic, and 74% whites. From 2010 to 2016, DOAC use increased from 0% to 36%, warfarin use decreased from 51% to 17%, and aspirin use remained relatively stable (42%-40%). After adjustment, blacks had higher odds of warfarin (odds ratio, 1.22; 95% CI, 1.07-1.40) prescription at discharge compared with whites. Men had higher rates of aspirin (42.1% versus 38.8%), warfarin (33.6% versus 28.9%), and DOAC (21.3% versus 19.3%) use compared with women. After adjustment, women had lower odds of being discharged on aspirin (odds ratio, 0.92; 95% CI, 0.86-0.98) or warfarin (odds ratio, 0.91; 95% CI, 0.84-0.99). There was no sex difference in use of DOACs. Conclusions- Our study confirmed the increasing use of DOACs, downtrending use of warfarin, whereas aspirin use remained similar over the years. There are sex and race-ethnicity disparities in anticoagulation use in IS patients with AF. It is critical to understand underlying drivers of these disparities to develop better practice strategies for stroke prevention in patients with AF. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT03627806.

AB - Background and Purpose- Ischemic stroke (IS) secondary to atrial fibrillation (AF) is largely preventable with the use of anticoagulation. We sought to identify race-ethnicity and sex disparities with the use of direct oral anticoagulants (DOACs), aspirin, and warfarin in IS patients with AF and to identify temporal trends in the utilization of these medications. Methods- The FLiPER-AF Stroke Study (Florida Puerto Rico Atrial Fibrillation) included 24 040 IS cases enrolled in the Florida-Puerto Rico Collaboration to Reduce Stroke Registry from 2010 to 2016. Multivariable logistic regression models were performed to evaluate the effect of race-ethnicity and sex on utilization of DOACs, aspirin, and warfarin for stroke prevention in AF after adjustment for sociodemographic, hospital, and clinical factors. Results- Among 24 040 IS cases, 54% were women and 10% black, 12% FL-Hispanics, 4% PR-Hispanic, and 74% whites. From 2010 to 2016, DOAC use increased from 0% to 36%, warfarin use decreased from 51% to 17%, and aspirin use remained relatively stable (42%-40%). After adjustment, blacks had higher odds of warfarin (odds ratio, 1.22; 95% CI, 1.07-1.40) prescription at discharge compared with whites. Men had higher rates of aspirin (42.1% versus 38.8%), warfarin (33.6% versus 28.9%), and DOAC (21.3% versus 19.3%) use compared with women. After adjustment, women had lower odds of being discharged on aspirin (odds ratio, 0.92; 95% CI, 0.86-0.98) or warfarin (odds ratio, 0.91; 95% CI, 0.84-0.99). There was no sex difference in use of DOACs. Conclusions- Our study confirmed the increasing use of DOACs, downtrending use of warfarin, whereas aspirin use remained similar over the years. There are sex and race-ethnicity disparities in anticoagulation use in IS patients with AF. It is critical to understand underlying drivers of these disparities to develop better practice strategies for stroke prevention in patients with AF. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT03627806.

KW - atrial fibrillation

KW - cerebrovascular disorders

KW - humans

KW - warfarin

KW - women

UR - http://www.scopus.com/inward/record.url?scp=85067266560&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067266560&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.118.023959

DO - 10.1161/STROKEAHA.118.023959

M3 - Article

C2 - 31084325

AN - SCOPUS:85067266560

VL - 50

SP - 1452

EP - 1459

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 6

ER -