title: Atrial fibrillation, stroke and anticoagulant use.
abstract: 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.
authors.affiliation: Department of the Elderly, Waikato Hospital, Hamilton, New Zealand.
authors.forename: Chandra
authors.initials: C
authors.lastname: Jayaraman
authors.forename: Raewyn
authors.initials: R
authors.lastname: Fisher
authors.forename: Paul
authors.initials: P
authors.lastname: Friedman
authors.forename: Gerard
authors.initials: G
authors.lastname: Devlin