An Audit of Anticoagulation for Atrial Fibrillation in a Stroke Unit population
Purpose. Atrial fibrillation is an important risk factor for ischaemic stroke and anticoagulation has been shown to reduce this risk in appropriate circumstances. Evidence suggests that warfarin therapy is underutilised, even in appropriate patients, implying that many strokes could possibly have been prevented. We therefore set out to assess the prevalence of atrial fibrillation (AF) in the stroke unit population of a tertiary referral hospital with a view to determining the prevalence of under-anticoagulation or non-anticoagulation at the time of stroke or TIA. We also set out to determine the proportion of patients anticoagulated at the time of discharge from the stroke unit, and to determine what reasons might underlie any failure to anticoagulate these patients.
Methods. A retrospective analysis was performed of all patients admitted to the Stroke Unit of the Canberra Hospital over the two-year period between October, 2004, and September, 2006. All patients with a diagnosis of AF, either old or new, were then selected from this group to determine anticoagulation status at the time of admission, and whether there were any contraindications to anticoagulation if patients were not anticoagulated.
Results. 503 patients were treated for stroke or TIA during the reference period, and of these approximately 28% were demonstrated to be in AF. Preliminary results suggest that the majority of patients with a prior diagnosis of AF were either not anticoagulated or were under-anticoagulated at the time of their ischaemic event, and that a large proportion of these patients had no contraindication to anticoagulation.
Conclusions. Our results confirm previous findings in the literature and indicate that a small but significant proportion of strokes could probably be prevented by better education of physicians, general practitioners and patients regarding anticoagulation of patients in AF.