RT Journal
A1 Shroff GR, Solid CA, Herzog CA
T1 Temporal trends in ischemic stroke and anticoagulation therapy among medicare patients with atrial fibrillation: A 15-year perspective (1992-2007)
JF JAMA Internal Medicine
JO JAMA Internal Medicine
YR 2013
FD January 28
VO 173
IS 2
SP 159
OP 160
DO 10.1001/jamainternmed.2013.1579
UL http://dx.doi.org/10.1001/jamainternmed.2013.1579
AB 
Atrial fibrillation (AF) is an independent, modifiable risk factor for ischemic stroke1 and independently associated with increased mortality.2 Nonvalvular AF is associated with a nearly 5-fold higher risk of ischemic stroke; this risk progressively increases with age.3 In a meta-analysis involving 29 clinical studies and 28 044 patients, judicious antithrombotic therapy with adjusted-dose warfarin was shown to reduce risk related to ischemic stroke by nearly 60% and mortality by approximately 25%, without significant increases in hemorrhagic stroke.4 However, diffusion of evidence-based knowledge from clinical trials into routine clinical practice demonstrates a significant time lag and evidence-to-practice gap; rates of ischemic stroke are therefore higher in clinical practice.5 We sought to extend previous work by Lakshminarayan et al6 to examine temporal trends in ischemic and hemorrhagic stroke rates and warfarin use in the Medicare population over a span of 15 years.