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(Stroke. 2000;31:2266.)
© 2000 American Heart Association, Inc.

Letters to the Editor

Underuse of Antithrombotic Therapy in Stroke Patients With Chronic Atrial Fibrillation

Antonio Villa, MD; Ambrogio Bacchetta, MD Ezio Omboni, MD

Emergency Department, Fatebenefratelli Hospital, Milan, Italy

Key Words: atrial fibrillation • stroke prevention • antithrombotic therapy

To the Editor:

The original contribution of Gage et al¹ on the underuse of antithrombotic therapy in Missouri Medicare draws attention to the resistance for general physicians to prescribe this therapy.

Data from our stroke register further emphasize this problem. In the Emergency Department of Fatebenefratelli Hospital (a central hospital in Milan, Italy), we are following an observational study on acute cerebrovascular accidents. Over approximately 20 months, we have recorded 1009 consecutive patients (884 with ischemic stroke, 88%; 125 hemorrhagic, 12%). In patients with ischemic stroke or transient ischemic attack (TIA) and presence of chronic nonvalvular atrial fibrillation (NVAF), we recorded the domiciliary therapy and the presence of additional stroke risk factors: age >75 years, previous ischemic stroke or TIA, previous diagnosis of arterial hypertension, chronic congestive heart failure, chronic ischemic heart disease, or type I or II diabetes. One hundred twenty-two of 884 ischemic patients (13.8%) had NVAF. Only 49 patients (40.2%) were taking antithrombotic therapy: aspirin (n=31, 25.4%), ticlopidine (n=6, 4.9%), indobufen (n=4, 3.3%), and oral anticoagulant (n=8; 6.6%); 73 patients (59.8%) were taking no prophylactic antithrombotic therapy. Associated risk factors were present in 96% of the patients: 21 patients (7 with prophylactic therapy and 14 not treated, 17.2%) had 1 risk factor, 39 patients (13 treated and 26 not treated, 31.9%) had 2 risk factors, and 57 patients (28 treated and 29 not treated) had 3 risk factors. The individual risk factors are presented in the Table.

View this table: [in this window] [in a new window]   Table 1. Individual Risk Factors in Patients With Ischemic Cerebrovascular Disease . . . [Full Text of this Article]

Brian F. Gage, , MD, MSc

Division of General Medical Sciences, Washington University School of Medicine, St Louis, Missouri

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