Stroke and atrial fibrillation: is stroke prevention treatment appropriatebeforehand?

Objective-To undertake a pilot study before conducting a large European mul ticentre prospective study, to determine the proportion of patients with at rial fibrillation who were not receiving antithrombotic treatment before st roke onset, and their characteristics. Design and patients-The stroke in atrial fibrillation ensemble (SAFE) I stu dy was an observational study conducted in 213 patients with atrial fibrill ation consecutively admitted in 1997 to three European centres for an acute stroke or transient ischaemic attack (TIA). It was determined whether they were receiving prior antithrombotic treatment. Results-Atrial fibrillation was known before stroke in 148 patients (69.5%) . Of 213 patients, 34 (16.0%) were receiving anticoagulation treatment befo re stroke, but only six had an international normalised ratio between 2.0 a nd 3.5; 65 (30.5%) were receiving antiplatelet treatment; and three (1.4%) were receiving both anticoagulation and antiplatelet treatment. Of 137 pati ents eligible for oral anticoagulation, 108 (78.8%) did not receive treatme nt. Of 142 patients eligible for any antithrombotic treatment, 62 (43.7%) w ere not treated. The logistic regression analysis, assuming anticoagulation treatment as a dependent variable, found digoxin treatment, absence of art erial hypertension, mitral stenosis, and cardioversion as independent facto rs. Assuming any antithrombotic treatment as a dependent variable, previous ly known atrial fibrillation, lower age, being a nonsmoker, and absence of arterial hypertension were found to be independent factors. Conclusion-More than half of the patients with atrial fibrillation admitted for acute stroke or TIA were not receiving any antithrombotic treatment be forehand. New onset atrial fibrillation and contraindications account for a minority of non-prescriptions; thus, other reasons should be identified to improve stroke prevention in the community.