An Analysis of Primary Prophylaxis in Middle-Aged and Elderly Stroke Patients with Atrial Fibrillation

Background. Atrial fibrillation (AF) is the cause of about 16-18% of ischemic strokes. The authors analyzed the preventive therapy applied in middle-aged and elderly patients with AF and completed ischemic stroke treated in three wards in a large city and a smaller town in Poland and the impact of the type of primary prevention on the death rate. Material and Methods. Patients with strokes were divided into three groups: those with a high risk (284/349 patients), an average risk (43/349 patients), and a low risk of stroke (22/349 patients) in the course of AF. Results. In the patients with a high risk of stroke, the primary prophylaxis was an antiplatelet drug (23.6%). Only in 7.4% (21/284) of those treated was an anticoagulant (AC) administered. The manner of conducting treatment was different from that recommended by stroke experts. Statistically significantly fewer patients (5.3%) taking an AC (acenocumarol, p < 0.001) died in comparison with those who did not (30.8%). The main cause of death was extensive ischemic stroke (72.6%) and in 7.1% of the cases it was secondary bleeding to an ischemic focus. Conclusions. Due to improper primary prophylaxis in patients with AF with a high risk of ischemic stroke, the authors recommend a simple blood test to estimate the INR of proper treatment and prophylaxis and also recommend the MMSE test for patients in the group at high risk of stroke prior to the start of anticoagulant treatment. Prophylaxes should be applied according to the recommendations of experts (Adv Clin Exp Med 2009, 18, 2, 141-146).