ANTITHROMBOTIC THERAPY PRESCRIBED FOR PATIENTS WITH NONRHEUMATIC ATRIAL-FIBRILLATION

Patients with non-rheumatic atrial fibrillation have a fivefold increa sed risk of stroke. Warfarin reduces this risk by approximately two th irds, but evidence for benefit from aspirin is less compelling. We ass essed whether our current practice reflects the message of the trials. In a retrospective case record study we reviewed notes of 131 patient s with atrial fibrillation (AF), mean age 79 (range 53-95) years, admi tted to a medical unit (72) or geriatric assessment unit (59). Thirty- two patients had paroxysmal AF. Of 115 patients with nonrheumatic AF, 36 (31%) had one or more recorded contraindication to anti-coagulation . Although 79 patients (69%) had no recorded contraindication to warfa rin, only 2 took warfarin and 15 aspirin prior to admission. Ten patie nts commenced warfarin and 8 aspirin before discharge. Thirty-nine pat ients (53%) without contraindication, were discharged without antithro mbotic therapy. Despite evidence to support anticoagulating patients w ith non-rheumatic AF, this rarely occurs.