Anticoagulant treatment in patients with atrial fibrillation and ischemic stroke

Abstract

Background: Atrial fibrillation (AF) is the most common cardiac dysrhythmia, with a lifetime risk of 25%, and it is a well-known independent risk factor for ischemic stroke. Over the last 15 years, efforts have been made to initiate relevant treatment in patients with AF. A retrospective study was set up to clarify whether this effort has resulted in a decreased proportion of patients with known AF experiencing an ischemic stroke.

Methods: Patients admitted to the Department of Neurology, Vejle Hospital, Denmark, with ischemic stroke from January 1997 to December 2012 were included in the study.

Results: A total of 4134 patients were included in the study. Overall, the yearly proportion of patients with known AF varied between 9% and 18%. No significant change was observed (P = .511). The proportion of patients with known AF treated with anticoagulants at the time of the stroke and the proportion of newly discovered AF were significantly increasing during the study period (P = .002 and P = .035, respectively). Subgroup analysis of the patients aged 65-75 years showed similar results.

Conclusions: No significant reduction in the proportion of patients admitted with ischemic stroke and AF was observed. An explanation could be an increase in the prevalence of AF in the general population, leaving the proportion of patients admitted with ischemic stroke unchanged. Other risk factors have been sought reduced as well with the implementation of national guidelines regarding hypertension, hypercholesterolemia, and diabetes.

Keywords: Atrial fibrillation; ischemic stroke; prevention; warfarin.