Atrial fibrillation, stroke and anticoagulant use.
BACKGROUND
Ischaemic stroke is reduced by anticoagulant therapy in high-risk patients with atrial fibrillation. Evidence however, suggests patients are under treated.


OBJECTIVE
To assess anticoagulant use in patients with ischaemic stroke and atrial fibrillation in Waikato Hospital.


METHODS
A retrospective review of all patients admitted with stroke over a one-year period.


RESULTS
Ischaemic stroke occurred in 189 patients with atrial fibrillation noted in 21% (39/189) of this group. The majority were female, 59% (23/39) with a mean age of 79.8 years. A total of 84% (33/39) were considered high risk for thromboembolic complications but only 18% (6/33) were anticoagulated prior to the stroke. Following the cerebrovascular accident all patients were considered to be at high risk but only a further 25% (10/39), were anticoagulated. In the remaining 55% (21/39) anticoagulant therapy was not commenced with age alone cited as a contraindication in 8% (3/39). At a mean follow-up of 10 months no complications of anticoagulant therapy were reported.


CONCLUSIONS
A significant proportion of patients with atrial fibrillation and high-risk characteristics are not anticoagulated prior to ischaemic stroke. These findings reflect overseas experience. Reasons are unknown but may in part relate to physician reluctance to anticoagulate elderly patients.
Jayaraman
Chandra
C
Department of the Elderly, Waikato Hospital, Hamilton, New Zealand.
Fisher
Raewyn
R
Friedman
Paul
P
Devlin
Gerard
G