Stroke and atrial fibrillation: is stroke prevention treatment appropriate beforehand?
D Deplanquea, F Coreab, C Arquizanc, L Parnettib, J L Masc, V Gallaib, D Leysa, and the SAFE I Study Investigators
a Department of
Neurology, Stroke Unit, University of Lille, Roger Salengro Hospital,
F-59037 Lille, France, b University of Perugia, Via Enrico dal Pozzo,
I-06126 Perugia, Italy, c Sainte-Anne Hospital, 1 rue Cabanis
F-75674 Paris, France
Correspondence to: Professor Leys. email: dleys{at}chru-lille.fr
Accepted for publication 22 June 1999
OBJECTIVE
To undertake
a pilot study before conducting a large European multicentre
prospective study, to determine the proportion of patients with atrial
fibrillation who were not receiving antithrombotic treatment before
stroke onset, and their characteristics.
DESIGN AND
PATIENTSThe stroke in atrial fibrillation
ensemble (SAFE) I study was an observational study conducted in 213 patients with atrial fibrillation 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.
RESULTSAtrial
fibrillation was known before stroke in 148 patients (69.5%). Of 213 patients, 34 (16.0%) were receiving anticoagulation treatment before
stroke, but only six had an international normalised ratio between 2.0 and 3.5; 65 (30.5%) were receiving antiplatelet treatment; and three
(1.4%) were receiving both anticoagulation and antiplatelet treatment.
Of 137 patients eligible for oral anticoagulation, 108 (78.8%) did not
receive treatment. Of 142 patients eligible for any antithrombotic
treatment, 62 (43.7%) were not treated. The logistic regression
analysis, assuming anticoagulation treatment as a dependent variable,
found digoxin treatment, absence of arterial hypertension, mitral
stenosis, and cardioversion as independent factors. Assuming any
antithrombotic treatment as a dependent variable, previously known
atrial fibrillation, lower age, being a non-smoker, and absence of
arterial hypertension were found to be independent factors.
CONCLUSIONMore than
half of the patients with atrial fibrillation admitted for acute stroke
or TIA were not receiving any antithrombotic treatment beforehand. 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.
Keywords: stroke; atrial fibrillation; anticoagulant treatment; antiplatelet treatment
© 1999 by Heart
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