Stroke due to atrial fibrillation and the attitude to prescribing anticoagulant prevention in Italy. A prospective study of a consecutive stroke population admitted to a comprehensive stroke unit.
BACKGROUND
Several studies have reported that oral anticoagulant prophylaxis (OAC) is under-used in patients with atrial fibrillation (AF).


OBJECTIVE
This study investigated the attitude to prescribing OAC in patients with AF observed in an Italian Stroke Unit (SU) and the severity of ischemic stroke due to AF in comparison with that of other etiologies.


METHODS
We prospectively studied a continuous series of acute stroke patients admitted to our SU from January 1, 2003 to December 31, 2005. Using Multiple Logistic Regression, we analyzed factors associated with the non-use of OAC and with poor prognosis.


RESULTS
Of 400 consecutive ischemic stroke patients, 103 (25.75 %) had AF; this group was older (mean age+/-sd= 79.74 +/- 10.15 years vs. 73.49 +/- 12.72; P = 0.0000045) and their strokes were more severe (NIHSS median value = 10 vs. 7, P < 0.002) in comparison with the group of patients whose strokes were due to other etiologies. Only 27.27% of patients with known AF, and without contraindications, were under OAC before the onset of stroke. The main independent factor associated with the non-use of OAC was old age. Moreover, AF proved to be a significant independent predictor of poor prognosis in our stroke population.


CONCLUSIONS
The results of this study indicate a marked under- use of OAC prophylaxis in AF subjects in Italy. Campaigns to raise awareness and to improve the implementation of guidelines on stroke prevention strategies are strongly recommended, not least because stroke due to AF has a worse prognosis.
Stroke Unit, Dept. of Neuroscience, Ophthalmology and Genetics, Faculty of Medicin, University of Genoa, Italy, Via De Toni 5, 16132 Genoa, Italy. gandcaci@unige.it
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Gandolfo
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Balestrino
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Burrone
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Del Sette
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Finocchi
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003159:Community-Institutional Relations / Q000592:standards; D004363:Drug Utilization; D004632:Emergency Medical Services / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000706:statistics & numerical data / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D011787:Quality of Health Care / Q000706:statistics & numerical data / Q000639:trends; D020521:Stroke / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*
D000925:Anticoagulants