Implementation of antithrombotic management in atrial fibrillation

The aim of the study was to assess the extent to which published recommenda tions on the antithrombotic management of atrial fibrillation had been adop ted into clinical practice in a busy district general hospital, and the imp act of clinical audit on subsequent management. In the initial audit, 185 c onsecutive patients with atrial fibrillation were studied using their case notes to identify any further clinical risk factors for stroke. A managemen t algorithm stratified patients with atrial fibrillation into high, moderat e, or low risk of stroke according to the individual stroke risk factors. F or patients at high risk, the correct treatment is warfarin unless there ar e specific contraindications. For patients at moderate risk, the correct ma nagement is aspirin unless there are specific contraindications. Patients a t low risk should receive no thromboprophylaxis. The clinical risks of stro ke and thromboprophylaxis on discharge from hospital were recorded. An exte nsive education programme on stroke prevention in atrial fibrillation was u ndertaken. Six months later a further 185 consecutive patients with atrial fibrillation were audited. Overall, a large proportion (306/370; 83%) of pa tients were at high risk of stroke. In the initial audit, antithrombotic ma nagement was correct in 89 patients (48%). In the follow up audit, antithro mbotic management was correct in 135 patients (73%) (p < 0.00001). If this improvement in management were extrapolated to all hospital patients in the United Kingdom, approximately 1400 strokes/ year could be avoided. Despite broad consensus in recent publications, antithrombotic management of atria l fibrillation remains imperfect, with many patients exposed to unnecessari ly high risk of stroke.