Stroke prevention in patients with atrial fibrillation

We evaluated the antithrombotic therapy and eligibility for anticoagulation before stroke in 30 patients with atrial fibrillation (AF) admitted to a district hospital in Kochi, Japan from 1992 to 1998. The mean age was 77+/-10 years old. Subtypes of ischemic stroke were classified as possibly cardioembolic in 26 (87%) patients and lacunar in four (13%). Eight (26.7%) patients died in the acute phase and 15 (50%) were disabled at discharge. Most patients were eligible for anticoagulation before stroke because of previously known AF (80%), high risk for stroke (80%), absence of contraindications (83.3%), and good clinical compliance (90%). The prescription rate of warfarin was, however, less than 20% even in high risk patients who needed anticoagulation. In conclusion, underuse of warfarin and high eligibility for anticoagulation in stroke patients with AF suggest that the chance of stroke prevention may be lost in many patients with AF in clinical practice.