Secondary prevention in patients with atrial fibrillation and stroke or transient ischemic attack - an insight from the FACTS programme

Abstract

Background. Cardioembolic stroke secondary to atrial fibrillation (AF) accounts for 1.5%-23.5% of all ischaemic strokes. Patients with prior stroke or transient ischaemic attack (TIA) are at high risk for stroke recurrence. Prognosis for patients with AF related stroke is worse than those with other types of stroke. According to the current guidelines secondary prevention in these patients should be based on anticoagulant therapy. Aim of the study. The purpose of this analysis is to evaluate the extent of anticoagulation in clinical practice in patients with previous stroke or TIA. Methods. We have evaluated records obtained from the FACTS registry. We included 374 patients with AF and a history of stroke or TIA, from different areas of Romania, and collected data regarding antithrombotic therapy. Results. According to CHADS2 all patients were at high risk and should receive anticoagulation therapy. In our group 51,37% were treated with OAC alone and 15,77% with OAC in combination with antiplatelet therapy. Of OAC the most used drug was acenocoumarol and optimal anticoagulation (INR between 2 and 3) was found in 68% patients. There were no differences between genders and OAC prescription was not influenced by AF type. OAC was preferred in 68.52% patients with high bleeding score (HASBLED > 3). Conclusion. The main finding of the analysis was that adherence to guidelines recommendation concerning AF patients with previous stroke/TIA is still low. However, patients at high risk for stroke recurrence and high bleeding score were mostly treated according to current recommendations, suggesting that there is an increasing awareness and adherence to current clinical guidelines.

Keywords

• atrial fi brillation
• stroke
• oral anticoagulation therapy
• adherence
• guidelines