Antithrombotic agents' use in patients with atrial fibrillation and acute cerebral ischemia.

Background: although trials suggest a benefit of aspirin, and not of anticoagulation (AC), in the acute stage of cerebral ischemia associated with atrial fibrillation (AF), many neurologists still use heparin.

Objective: to evaluate how antithrombotic agents were used at the acute stage of cerebral ischemia in AF patients after the publication of trials and guidelines.

Methods: we reviewed the charts of all patients with AF who were admitted between 1996 and 2002 as primary care patients, within 48 hours after onset of an ischemic stroke (IS) or transient ischemic attacks (TIAs). We recorded the first antithrombotic treatment prescribed at admission.

Results: in 763 consecutive patients (42% men; median age 79 years), the use of AC on admission decreased over time from 70% to 22% (p<0.001), while antiplatelet agents increased from 27% to 78% (p<0.001). Patients who received AC were more likely to be younger, to have a Barthel index >60, no hemorrhagic changes, and to have been admitted in 1996 or 1997. Results were similar between patients with IS and TIAs and in patients who were not under AC before. In patients who were under oral AC before, AC use at admission did not decline over time (p=0.366).

Conclusion: there was a clear decrease in AC use during the study period, except in patients who were already under AC before, and in TIA patients.