Underuse of anticoagulation in stroke patients with atrial fibrillation--the FibStroke Study.
OBJECTIVE
Current guidelines recommend oral anticoagulation (OAC) for patients with atrial fibrillation (AF) and increased risk of thromboembolic events. The reasons for not using OAC in AF patients suffering stroke or transient ischaemic attack (TIA) were assessed.


METHODS
This retrospective registry included 3404 patients with previously diagnosed AF who suffered a total of 2955 ischaemic strokes and 895 TIAs during 2003-2012.


RESULTS
A CHA2DS2-VASc score ≥2 and a CHADS2 score ≥2 was observed in 3590 (93.2%) and in 2784 (72.3%) of the events, respectively. Of the high-risk patients (CHADS2 ≥2) only 55.1% were on OAC before the onset of stroke or TIA. The most frequently documented reasons for withholding OAC were infrequent paroxysms of AF (14%), previous bleeding episodes (13%) and the patient's decline/independent discontinuation of treatment (9%). Moreover, patients with paroxysmal AF (40% using OAC), previous bleeding (26% using OAC) and alcohol abuse (30% using OAC) were using OAC significantly less often than patients without these characteristics. A significant increase in the proportion of high-risk patients using OAC from 49% in 2003 to 65% in 2012 was seen.


CONCLUSIONS
Underuse of anticoagulation is a common contributor to ischaemic strokes and TIA episodes in patients with AF. Infrequent AF episodes, previous bleeds, patient preference and alcohol abuse were the most common reasons for not using OAC.
Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
A
A
Palomäki
Department of Medicine, Keski-Suomi Central Hospital, Jyväskylä, Finland.
P
P
Mustonen
Heart Center, Kuopio University Hospital, Kuopio, Finland.
J E K
JE
Hartikainen
Department of Medicine, Turku University Hospital and University of Turku, Turku, Finland.
I
I
Nuotio
Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
T
T
Kiviniemi
Heart Center, Satakunta Central Hospital, Pori, Finland.
A
A
Ylitalo
Neuro Center, Neurology, Kuopio University Hospital, Kuopio, Finland.
P
P
Hartikainen
Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
K E J
KE
Airaksinen
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012306:Risk; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*
D000925:Anticoagulants
TIA; anticoagulation; atrial fibrillation; stroke