Atrial fibrillation, stroke and anticoagulant use

Area of Science:

• Cardiology
• Neurology
• Public Health

Background:

• Anticoagulant therapy effectively reduces ischaemic stroke risk in atrial fibrillation patients.
• Evidence suggests current anticoagulant use in high-risk patients is suboptimal.

Purpose of the Study:

• To evaluate anticoagulant prescribing patterns in patients with ischaemic stroke and atrial fibrillation at Waikato Hospital.

Main Methods:

• Retrospective review of stroke admissions over one year.
• Analysis of patient demographics, stroke risk factors, and anticoagulant use.

Main Results:

• 21% of ischaemic stroke patients had atrial fibrillation; 84% were high risk for thromboembolism.
• Only 18% of high-risk patients received anticoagulation pre-stroke.
• Post-stroke, only 25% were anticoagulated, with physician reluctance to treat elderly patients cited as a reason for non-initiation.

Conclusions:

• A substantial number of high-risk atrial fibrillation patients with ischaemic stroke are not anticoagulated.
• This undertreatment mirrors international trends and may stem from physician hesitancy in treating elderly individuals.
• Further investigation into the reasons for under-anticoagulation is warranted.