{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T00:37:47Z","timestamp":1773535067848,"version":"3.50.1"},"reference-count":32,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,6,11]]},"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Because of their high risk of stroke, anticoagulation therapy is recommended for most patients with atrial fibrillation (AF). The present study evaluated the use of anticoagulants in the community and in a hospital setting for patients with AF and its associations with stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients admitted with stroke to four major hospitals in County of Surrey, England were surveyed in the 2014\u20132016 Sentinel Stroke National Audit Programme. Descriptive statistics was used to summarise subject characteristics and \u03c7\u00b2 test to assess differences between categorical variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 3309 patients, 1656 men (mean age: 73.1\u2009years\u00b1SD 13.2) and 1653 women (79.3\u2009years\u00b113.0) were admitted with stroke (83.3% with ischaemic, 15.7% haemorrhagic stroke and 1% unspecified). AF occurred more frequently (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      =62.4; p&lt;0.001) among patients admitted with recurrent (30.2%) rather than with first stroke (17.1%). There were 666 (20.1%) patients admitted with a history of AF, among whom 304 (45.3%) were anticoagulated, 279 (41.9%) were untreated and 85 (12.8%) deemed unsuitable for anticoagulation. Of the 453 patients with history of AF admitted with a first ischaemic stroke, 138 (37.2%) were on anticoagulation and 41 (49.6%) were not (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      = 6.3; p&lt;0.043) and thrombolysis was given more frequently for those without prior anticoagulation treatment (16.1%) or unsuitable for anticoagulation (23.6%) compared with those already on anticoagulation treatment (8.3%; \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      =10.0; p=0.007). Of 2643 patients without a previous history of AF, 171 (6.5%) were identified with AF during hospitalisation. Of patients with AF who presented with ischaemic stroke who were not anticoagulated or deemed unsuitable for anticoagulation prior to admission, 91.8% and 75.0%, respectively, were anticoagulated on discharge.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The study highlights an existing burden for patients with stroke and reflects inadequate treatment of AF which results in an increased stroke burden. There is significant scope to improve the rates of anticoagulation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-022558","type":"journal-article","created":{"date-parts":[[2018,7,11]],"date-time":"2018-07-11T08:32:09Z","timestamp":1531297929000},"page":"e022558","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":19,"title":["Anticoagulation therapy in patients with stroke and atrial fibrillation: a registry-based study of acute stroke care in Surrey, UK"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2570-0938","authenticated-orcid":false,"given":"Thang S","family":"Han","sequence":"first","affiliation":[{"name":"Institute of Cardiovascular Research, Royal Holloway, University of London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher Henry","family":"Fry","sequence":"additional","affiliation":[{"name":"School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Fluck","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ashford and St Peter\u2019s NHS Foundation Trust, Chertsey, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brendan","family":"Affley","sequence":"additional","affiliation":[{"name":"Department of Stroke, Ashford and Saint Peter\u2019s Hospitals NHS Trust, Chertsey, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giosue","family":"Gulli","sequence":"additional","affiliation":[{"name":"Department of Stroke, Ashford and Saint Peter\u2019s Hospitals NHS Trust, Chertsey, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Barrett","sequence":"additional","affiliation":[{"name":"Department of Stroke, NHS Frimley Health Foundation Trust, Frimley, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Puneet","family":"Kakar","sequence":"additional","affiliation":[{"name":"Department of Stroke, Epsom and St Helier University Hospitals, Epsom, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tasmin","family":"Patel","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Research, Royal Holloway, University of London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sapna","family":"Sharma","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Research, Royal Holloway, University of London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pankaj","family":"Sharma","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Research, Royal Holloway, University of London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,7,11]]},"reference":[{"key":"2025121512404783000_8.7.e022558.1","unstructured":"WHO. http:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cardiovascular-diseases-(cvds)"},{"key":"2025121512404783000_8.7.e022558.2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.32.2.392"},{"key":"2025121512404783000_8.7.e022558.3","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2016-313361"},{"key":"2025121512404783000_8.7.e022558.4","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.116.015242"},{"key":"2025121512404783000_8.7.e022558.5","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.29.8.1605"},{"key":"2025121512404783000_8.7.e022558.6","doi-asserted-by":"publisher","DOI":"10.1191\/0269215503cr613oa"},{"key":"2025121512404783000_8.7.e022558.7","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000155690.04697.c0"},{"issue":"Suppl 1","key":"2025121512404783000_8.7.e022558.8","doi-asserted-by":"crossref","first-page":"43","DOI":"10.2165\/00019053-200321001-00005","article-title":"The economic burden of stroke in the United Kingdom","volume":"21 Suppl 1","author":"Youman","year":"2003","journal-title":"Pharmacoeconomics"},{"key":"2025121512404783000_8.7.e022558.9","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afn281"},{"key":"2025121512404783000_8.7.e022558.10","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.22.8.983"},{"key":"2025121512404783000_8.7.e022558.11","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1994.00420130036007"},{"key":"2025121512404783000_8.7.e022558.12","doi-asserted-by":"crossref","first-page":"927","DOI":"10.7326\/0003-4819-131-12-199912210-00004","article-title":"Warfarin use among ambulatory patients with nonvalvular atrial fibrillation: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study","volume":"131","author":"Go","year":"1999","journal-title":"Ann Intern Med"},{"key":"2025121512404783000_8.7.e022558.13","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-146-12-200706190-00007"},{"key":"2025121512404783000_8.7.e022558.14","unstructured":"Royal College of Physicians. Clinical effectiveness and evaluation unit on behalf of the intercollegiate stroke working party. SSNAP January - March 2016. Public Report. https:\/\/www.strokeaudit.org\/Documents\/National\/AcuteOrg\/2016\/2016-AOANationalReport.aspx"},{"key":"2025121512404783000_8.7.e022558.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.07.010"},{"key":"2025121512404783000_8.7.e022558.16","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eus305"},{"key":"2025121512404783000_8.7.e022558.17","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000145"},{"key":"2025121512404783000_8.7.e022558.18","unstructured":"NICE (National-Institute-for-Health-and-Care-Excellence). Atrial fibrillation: the management of atrial fibrillation. 2014. http:\/\/guidance.nice.org.uk\/CG180 (Clinical guideline 180)"},{"key":"2025121512404783000_8.7.e022558.19","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw233"},{"key":"2025121512404783000_8.7.e022558.20","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.82.5.570"},{"key":"2025121512404783000_8.7.e022558.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.06.077"},{"key":"2025121512404783000_8.7.e022558.22","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-019122","article-title":"Evaluation of anticoagulation status for atrial fibrillation on early ischaemic stroke outcomes: a registry-based, prospective cohort study of acute stroke care in Surrey, UK","volume":"7","author":"Han","year":"2017","journal-title":"BMJ Open"},{"key":"2025121512404783000_8.7.e022558.23","unstructured":"NICE. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management [CG68]. www.nice.org.uk\/guidance\/cg68\/uptake"},{"key":"2025121512404783000_8.7.e022558.24","doi-asserted-by":"publisher","DOI":"10.1185\/030079905X61956"},{"key":"2025121512404783000_8.7.e022558.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2005.07.031"},{"key":"2025121512404783000_8.7.e022558.26","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.573907"},{"key":"2025121512404783000_8.7.e022558.27","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.8.737"},{"key":"2025121512404783000_8.7.e022558.28","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30443-3"},{"key":"2025121512404783000_8.7.e022558.29","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-307550"},{"key":"2025121512404783000_8.7.e022558.30","doi-asserted-by":"publisher","DOI":"10.3121\/cmr.2009.851"},{"key":"2025121512404783000_8.7.e022558.31","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euv269"},{"key":"2025121512404783000_8.7.e022558.32","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/501658"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2018-022558","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T20:40:53Z","timestamp":1765831253000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2018-022558"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7]]},"references-count":32,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2018,7,11]]},"published-print":{"date-parts":[[2018,7]]}},"alternative-id":["10.1136\/bmjopen-2018-022558"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2018-022558","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7]]}}}