WARFARIN USE FOLLOWING ISCHEMIC STROKE AMONG MEDICARE PATIENTS WITH ATRIAL-FIBRILLATION

Background: Elderly patients with ischemic stroke and atrial fibrillat ion are at especially increased risk for recurrent stroke. Warfarin so dium is highly effective in reducing this risk. Objective: To determin e the use of warfarin among a population sample of elderly patients wi th atrial fibrillation hospitalized for ischemic stroke. Methods: The Connecticut Peer Review Organization conducted a chart review of Medic are patients, aged 65 years or older, hospitalized in 1994 with a diag nosis of atrial fibrillation. Patients with a principal diagnosis of a cute myocardial infarction or another indication for anticoagulation w ere excluded. Results: Among 635 patients (402 women; 585 white; 218 g reater than or equal to 85 years old; 147 with a new diagnosis of atri al fibrillation), 334 had stroke as a principal diagnosis. Among those discharged alive after a stroke, only 147 (53%) of 278 were prescribe d warfarin at discharge. Furthermore, among 130 (47%) of 278 patients not prescribed warfarin at discharge, 81 (62%) of 130 were also not pr escribed aspirin. Increased potential benefit (additional vascular ris k factors) was not associated with a higher rate of warfarin use. Low risk for anticoagulation (lack of risk factors for bleeding) was assoc iated with a slightly higher rate of warfarin use. Among those with an increased risk of stroke and a low risk for bleeding (ideal candidate s), 124 (62%) of 278 were discharged on a regimen of warfarin. Conclus ion: Anticoagulation of elderly stroke patients with atrial fibrillati on, even among ideal candidates, is underused. The increased use of wa rfarin among these patients represents an excellent opportunity for re ducing the risk of recurrent stroke in this high-risk population.