Prevention of cardioembolic stroke: use of oral anticoagulants in patientswith atrial fibrillation

With the aim of quantifying the use of oral anticoagulant (OA) therapy in c linical practice, we surveyed 150 consecutive patients admitted with a diag nosis of atrial fibrillation (AF). Each patient was administered a question naire relating to the classic vascular risk factors and to the antithrombot ic treatment received at home. The diagnosis of AF was formulated at the time of admission in 45 cases. Of the 105 cases with a previous diagnosis, OA therapy was relatively or abso lutely contraindicated in 21 patients (20%), whereas the other 84 (80%) wer e ideal candidates for the treatment. Of these, 20 (24%) were actually rece iving OA, 16 (19%) were on platelet anti-aggregants (PA), and 48 (57%) were receiving no antithrombotic treatment at all. Even lower percentages of OA use were found in the patients with a previous (20%) or recent (16%) histo ry of cerebral ischemia. Upon discharge, of the 115 patients without contra indications to OA (84 with previously known and 31 with newly diagnosed AF) , 50% were receiving OA and 20% PA. The results of this survey show that OA therapy is little used in the Valle d'Aosta Region for the prevention of ischemic stroke in AF; patients at hi gh risk for cerebral ischemia. The lack of knowledge among the general popu lation, the difficulty of initiating the therapy in patients such as ours w ith severe comorbidities, and the absence or disorganization of centers for OA monitoring may be the main reasons underlying this low level of use. Po pulation screening or a sensitization campaign could increase the identific ation of subjects at risk, whereas better organization of coagulation monit oring centers could encourage OA use in subjects at high risk for cerebral ischemia.