Evaluating the link between atrial fibrillation, anticoagulant treatment and the risk of stroke

This study looked at the association between anticoagulant medication used in patients with atrial fibrillation (AF, irregular heartbeat) and its association with stroke. The authors found that AF is commonly undertreated which can impact the risk of stroke.

Atrial fibrillation (AF) is one of the highest risk factors for stroke. To prevent stroke, it is recommended that patients with AF are treated with anticoagulant drugs. These medications help to prevent blood clots from forming. Some evidence suggests however that AF is undertreated in the community, which can lead to increased rates of stroke. Therefore, it is important to look at the rates of AF treatment with anticoagulants in different communities.

The authors of this study collected data from patients who were admitted for stroke to 4 main hospitals across Surrey, England. Overall, a total of 3309 patients were included. 76.9% of patients were admitted with a first-time stroke, while 23.1% had a recurrent stroke.

There were 666 (20.1%) patients with a history of AF. 30.2% of patients with recurrent stroke had a history of AF, while only 17.2% of patients with a first-time stroke had AF. Of the 666 patients, almost half (45.3%) of them were being treated with anticoagulants, while 41.9% were untreated. The remaining 12.8% patients were unsuitable for anticoagulant treatment. Patients with a hemorrhagic stroke (caused by a leaking or bursting of a blood vessel in the brain) were more often on anticoagulant treatment compared to those with ischemic stroke (caused by a blocked blood vessel in the brain).

Thrombolysis (breaking up a blood clot once it has formed) was needed for 16.1 – 23.6% of patients who had not received previous anticoagulant therapy, and in only 8.3% of the patients who had already been treated with anticoagulants.

Of the 2643 patients who had no history of AF, 6.5% were diagnosed with AF upon hospital admission. By the time these patients were discharged, over 88% were receiving anticoagulant medication.

The authors concluded that there was an inadequate treatment of AF in the community which resulted in a higher risk of stroke.

The authors of the study did not have information on the type of anticoagulant used in these patients or why some of the patients were not put on this therapy. These data might impact the results of the study.

Also, the study only looked at patients in a small community in England. These results might not apply to all patients.

Discuss with your physician your best option to reduce the risk of the stroke.