Antithrombotic treatments in patients with acute ischemic stroke and non-valvular atrial fibrillation before introduction of non-Vitamin K antagonist oral anticoagulants into practice in Korea

Hee Joon Bae, Ji Hoe Heo, Keun Hwa Jung, Yong Seok Lee, Keun Sik Hong, Woo Keun Seo, Jaseong Koo, Jae Kwan Cha, Mi Ji Lee, Bo Jeong Seo, Young Joo Kim, Seongsik Kang, Jinmi Seok, Juneyoung Lee, Chin Sang Chung

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Abstract

Background This study aimed to describe patterns of long-term antithrombotic use in acute ischemic stroke (AIS) patients with non-valvular atrial fibrillation (NVAF) in Korea and their impacts on clinical events before introduction of non-vitamin K antagonist oral anticoagulants (NOAC) into practice in 2015. Methods Patients with NVAF who were admitted due to the AIS and discharged no later than 2008 were enrolled retrospectively. Data were collected at 11 time points during the first 3 years of follow-up. The primary outcome event was a composite of stroke recurrence, major bleeding, and death. Vitamin K antagonist (VKA) users were categorized into a well-controlled INR group and a poorly-controlled INR group (modified TTR 47.0% vs <47.0%). Results Of 1,350 patients enrolled in this study, 95% were on antithrombotic medications at discharge. The rate of VKA usage decreased over time (77% and 40% at discharge and 3 years, respectively). The cumulative event rates of the primary outcome differed by treatment patterns. Among the 10 most frequent treatment types, the highest outcome rate was observed in patients who started with VKA-only therapy but discontinued VKAs during follow-up without restarting (70.2%); this was followed by those starting with antiplatelet-only therapy and stopping it without restart (66.7%). Among VKA users, the 3-year cumulative primary outcome rates were higher in the poorly-controlled INR group than the well-controlled INR group (24.5% vs 15.7%; p = 0.015). Conclusion Our study revealed that, in pre-NOAC era, there was a wide spectrum of long-term antithrombotic use. The incidence of the composite outcome also varied by patterns of antithrombotic use.

Original languageEnglish
Article numbere0202803
JournalPLoS One
Volume13
Issue number11
DOIs
Publication statusPublished - 2018 Nov 1

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International Normalized Ratio
anticoagulants
Vitamin K
Korea
stroke
Anticoagulants
Atrial Fibrillation
Korean Peninsula
antagonists
mouth
vitamin K
Stroke
Composite materials
Therapeutics
therapeutics
Hemorrhage
Recurrence
drug therapy
hemorrhage
atrial fibrillation

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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Antithrombotic treatments in patients with acute ischemic stroke and non-valvular atrial fibrillation before introduction of non-Vitamin K antagonist oral anticoagulants into practice in Korea. / Bae, Hee Joon; Heo, Ji Hoe; Jung, Keun Hwa; Lee, Yong Seok; Hong, Keun Sik; Seo, Woo Keun; Koo, Jaseong; Cha, Jae Kwan; Lee, Mi Ji; Seo, Bo Jeong; Kim, Young Joo; Kang, Seongsik; Seok, Jinmi; Lee, Juneyoung; Chung, Chin Sang.

In: PLoS One, Vol. 13, No. 11, e0202803, 01.11.2018.

Research output: Contribution to journalArticle

Bae, HJ, Heo, JH, Jung, KH, Lee, YS, Hong, KS, Seo, WK, Koo, J, Cha, JK, Lee, MJ, Seo, BJ, Kim, YJ, Kang, S, Seok, J, Lee, J & Chung, CS 2018, 'Antithrombotic treatments in patients with acute ischemic stroke and non-valvular atrial fibrillation before introduction of non-Vitamin K antagonist oral anticoagulants into practice in Korea', PLoS One, vol. 13, no. 11, e0202803. https://doi.org/10.1371/journal.pone.0202803
Bae, Hee Joon ; Heo, Ji Hoe ; Jung, Keun Hwa ; Lee, Yong Seok ; Hong, Keun Sik ; Seo, Woo Keun ; Koo, Jaseong ; Cha, Jae Kwan ; Lee, Mi Ji ; Seo, Bo Jeong ; Kim, Young Joo ; Kang, Seongsik ; Seok, Jinmi ; Lee, Juneyoung ; Chung, Chin Sang. / Antithrombotic treatments in patients with acute ischemic stroke and non-valvular atrial fibrillation before introduction of non-Vitamin K antagonist oral anticoagulants into practice in Korea. In: PLoS One. 2018 ; Vol. 13, No. 11.
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abstract = "Background This study aimed to describe patterns of long-term antithrombotic use in acute ischemic stroke (AIS) patients with non-valvular atrial fibrillation (NVAF) in Korea and their impacts on clinical events before introduction of non-vitamin K antagonist oral anticoagulants (NOAC) into practice in 2015. Methods Patients with NVAF who were admitted due to the AIS and discharged no later than 2008 were enrolled retrospectively. Data were collected at 11 time points during the first 3 years of follow-up. The primary outcome event was a composite of stroke recurrence, major bleeding, and death. Vitamin K antagonist (VKA) users were categorized into a well-controlled INR group and a poorly-controlled INR group (modified TTR 47.0{\%} vs <47.0{\%}). Results Of 1,350 patients enrolled in this study, 95{\%} were on antithrombotic medications at discharge. The rate of VKA usage decreased over time (77{\%} and 40{\%} at discharge and 3 years, respectively). The cumulative event rates of the primary outcome differed by treatment patterns. Among the 10 most frequent treatment types, the highest outcome rate was observed in patients who started with VKA-only therapy but discontinued VKAs during follow-up without restarting (70.2{\%}); this was followed by those starting with antiplatelet-only therapy and stopping it without restart (66.7{\%}). Among VKA users, the 3-year cumulative primary outcome rates were higher in the poorly-controlled INR group than the well-controlled INR group (24.5{\%} vs 15.7{\%}; p = 0.015). Conclusion Our study revealed that, in pre-NOAC era, there was a wide spectrum of long-term antithrombotic use. The incidence of the composite outcome also varied by patterns of antithrombotic use.",
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T1 - Antithrombotic treatments in patients with acute ischemic stroke and non-valvular atrial fibrillation before introduction of non-Vitamin K antagonist oral anticoagulants into practice in Korea

AU - Bae, Hee Joon

AU - Heo, Ji Hoe

AU - Jung, Keun Hwa

AU - Lee, Yong Seok

AU - Hong, Keun Sik

AU - Seo, Woo Keun

AU - Koo, Jaseong

AU - Cha, Jae Kwan

AU - Lee, Mi Ji

AU - Seo, Bo Jeong

AU - Kim, Young Joo

AU - Kang, Seongsik

AU - Seok, Jinmi

AU - Lee, Juneyoung

AU - Chung, Chin Sang

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Background This study aimed to describe patterns of long-term antithrombotic use in acute ischemic stroke (AIS) patients with non-valvular atrial fibrillation (NVAF) in Korea and their impacts on clinical events before introduction of non-vitamin K antagonist oral anticoagulants (NOAC) into practice in 2015. Methods Patients with NVAF who were admitted due to the AIS and discharged no later than 2008 were enrolled retrospectively. Data were collected at 11 time points during the first 3 years of follow-up. The primary outcome event was a composite of stroke recurrence, major bleeding, and death. Vitamin K antagonist (VKA) users were categorized into a well-controlled INR group and a poorly-controlled INR group (modified TTR 47.0% vs <47.0%). Results Of 1,350 patients enrolled in this study, 95% were on antithrombotic medications at discharge. The rate of VKA usage decreased over time (77% and 40% at discharge and 3 years, respectively). The cumulative event rates of the primary outcome differed by treatment patterns. Among the 10 most frequent treatment types, the highest outcome rate was observed in patients who started with VKA-only therapy but discontinued VKAs during follow-up without restarting (70.2%); this was followed by those starting with antiplatelet-only therapy and stopping it without restart (66.7%). Among VKA users, the 3-year cumulative primary outcome rates were higher in the poorly-controlled INR group than the well-controlled INR group (24.5% vs 15.7%; p = 0.015). Conclusion Our study revealed that, in pre-NOAC era, there was a wide spectrum of long-term antithrombotic use. The incidence of the composite outcome also varied by patterns of antithrombotic use.

AB - Background This study aimed to describe patterns of long-term antithrombotic use in acute ischemic stroke (AIS) patients with non-valvular atrial fibrillation (NVAF) in Korea and their impacts on clinical events before introduction of non-vitamin K antagonist oral anticoagulants (NOAC) into practice in 2015. Methods Patients with NVAF who were admitted due to the AIS and discharged no later than 2008 were enrolled retrospectively. Data were collected at 11 time points during the first 3 years of follow-up. The primary outcome event was a composite of stroke recurrence, major bleeding, and death. Vitamin K antagonist (VKA) users were categorized into a well-controlled INR group and a poorly-controlled INR group (modified TTR 47.0% vs <47.0%). Results Of 1,350 patients enrolled in this study, 95% were on antithrombotic medications at discharge. The rate of VKA usage decreased over time (77% and 40% at discharge and 3 years, respectively). The cumulative event rates of the primary outcome differed by treatment patterns. Among the 10 most frequent treatment types, the highest outcome rate was observed in patients who started with VKA-only therapy but discontinued VKAs during follow-up without restarting (70.2%); this was followed by those starting with antiplatelet-only therapy and stopping it without restart (66.7%). Among VKA users, the 3-year cumulative primary outcome rates were higher in the poorly-controlled INR group than the well-controlled INR group (24.5% vs 15.7%; p = 0.015). Conclusion Our study revealed that, in pre-NOAC era, there was a wide spectrum of long-term antithrombotic use. The incidence of the composite outcome also varied by patterns of antithrombotic use.

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