The use of antithrombotics in patients presenting with stroke and atrial fibrillation

Antithrombotics have been shown to decrease the risk of stroke in patients with atrial fibrillation (AF). However they are associated with an increased risk of bleeding. We assessed the frequency and appropriateness of antithrombotic therapy in patients admitted to our service with stroke and AF. A retrospective case study of 219 patients (mean age 77.2 years) admitted between January 1999 and 31 December 2001 with a diagnosis of stroke and AF was done. Patient characteristics, presence of comorbid conditions, knowledge of preadmission AF, medication history and appropriateness of antithrombotic treatment were recorded. One hundred and fifty patients were known to have had AF prior to admission. Forty-one presented with an intracranial hemorrhage (19 on warfarin, 10 on aspirin). Of those patients with known AF only 43 were on treatment consistent with the guidelines. Warfarin was recommended in 144 of the whole cohort, but only 39 were taking it. Fifty-three patients were receiving aspirin although warfarin was the recommended treatment. Fifty-four with known AF were not on any antithrombotic treatment. Factors significantly associated with the use of antithrombotic treatment were history of AF (p = 0.0004), valvular heart disease (p = 0.02), venous thromboembolism (p = 0.04), risk of thromboembolism (p = 0.003) and presentation with a nonischemic infarct (p = 0.008). Antithrombotic therapy use in our patients differs significantly from guideline recommendations.