[Antithrombotic therapy in patients with first-ever stroke and known non-rheumatic atrial fibrillation].
Patients with non-rheumatic atrial fibrillation (AF) have an increased risk for ischemic stroke. The presence of risk factors such as a history of ischemic stroke, transient ischemic attack, diabetes mellitus, arterial hypertension or advanced age allows the classification of patients with AF in three groups with high, moderate, and low stroke risk. High-risk patients should receive oral anticoagulants, low-risk patients aspirin, and moderate-risk patients one of both antithrombotic agents. However, primary stroke prevention studies suggest that many high-risk patients are not anticoagulated, whereas low risk patients receive anticoagulants instead of aspirin. Our retrospective analysis of prospectively collected data examined the antithrombotic therapy of patients with first-ever stroke and known non-valvular AF and compared the results with the recommendations of the Atrial Fibrillation Investigators (AFI) and the Stroke Prevention in Atrial Fibrillation (SPAF) study. Contraindications against anticoagulation were taken into consideration. High-risk patients received in 36% an appropriate antithrombotic therapy according to the AFI-guidelines, and in 28% according to the SPAF-guidelines. About one quarter of low-risk patients were anticoagulated unnecessarily. Our study confirms that many patients with AF and high stroke risk do not get the appropriate antithrombotic therapy, while some patients with low-risk are anticoagulated without cause.
Gandjour
J
J
Abteilung für Neuroangiologie, Neurologische Klinik und Poliklinik, Universitätsspital Zürich.
Zeindler
J
J
Georgiadis
D
D
Baumgartner
R W
RW
D000284:Administration, Oral; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D003374:Coumarins / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011322:Primary Prevention; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control
D000925:Anticoagulants; D003374:Coumarins; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; C030123:coumarin; D001241:Aspirin