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(Stroke. 1999;30:1218-1222.)
© 1999 American Heart Association, Inc.
Original Contributions |
Risk Assessment and Anticoagulation for Primary Stroke Prevention in Atrial Fibrillation
From the Orpington Stroke Unit, Clinical and Health Services Studies Unit, King's College School of Medicine & Dentistry, London, UK.
Correspondence to Dr L. Kalra, Department of Medicine, King's College School of Medicine & Dentistry, Bessemer Road, London SE5 9PJ, UK. E-mail lalit.kalra{at}kcl.ac.uk
Background and Purpose—Risk assessment before anticoagulation is important for effective stroke prevention in atrial fibrillation (AF).
Methods—A study was undertaken in patients with AF to investigate the contribution of clinical and echocardiography (ECHO) criteria to treatment decisions on anticoagulation. Patients were stratified by age and stroke risk; contraindications to anticoagulation and warfarin use were assessed. The value of ECHO in treatment decisions, effect of age, and existing anticoagulation practice were evaluated.
Results—The mean±SD age of 234 patients was 67.1±11.8 years,
and 122 (52%) were women. Clinical risk factors were present in 74
of 80 patients (92%) aged >75 years compared with 99 of 154 patients
(64%) 
75 years (P<0.01). ECHO risk was identified in
94 of 154 patients (61%) 75 years, 16 (17%) of whom had no clinical
risk factors. ECHO risk was present in 71 patients (88%) >75
years of age, and was associated with clinical risk factors in all
patients. Eligibility for anticoagulation was seen in 72 of 154 (47%)
to 105 of 154 (68%) patients aged 75 years, depending on the
criteria used, and in 66 of 80 patients (83%) >75 years, regardless
of criteria used (P<0.01). Warfarin was being used in
55 of 105 patients (51%) 75 years and 8 of 66 patients (12%) >75
years (P<0.001). Anticoagulation was being undertaken
in 7 of 49 patients (14%) 75 years despite no clinical or ECHO
risks.
Conclusions—Accurate assessments of eligibility and
appropriateness of anticoagulation in AF can be made on clinical
criteria alone, especially in older people. The value of ECHO in
treatment decisions is limited to patients 75 years of age with no
clinical risk factors.
Key Words: aged • anticoagulants • atrial fibrillation • echocardiography • prevention, primary • risk factors
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