3ANTICOAGULATION AUDIT OF ATRIAL FIBRILLATION IN PATIENTS WITH TRANSIENT ISCHAEMIC ATTACK OR ISCHAEMIC STROKE

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Abstract

Introduction: Patients with atrial fibrillation and transient ischaemic attack or ischaemic stroke are at high risk (4–18% annual risk) of stroke. Anticoagulation (ACTIVE trial, NICE guidance and ESO guidance) remains the most effective measure in reducing the risk of stroke when compared with antiplatelets in these patients. In patients where anticoagulation is contraindicated antiplatelet agents (international stroke trial and CAPRIE trial) should be considered. Anticoagulated patients should have antihypertensive therapy (ESO guidance) to reduce the risk of cerebral haemorrhage.

Method: Patients with atrial fibrillation and transient ischaemic attack or stroke are identified as eligible patient for anticoagulation. In patients where anticoagulation is contraindicated antiplatelet agents are offered. All the eligible patients were considered for hypertension management.

The audit was done in year 2010 and above strategies implemented and the re-audit was done during year 2012. A total number of patients involved are 49.

Results: Comparison of two data (2010 and 2012) groups showed as follows:

Conclusion: The presence of validated risk assessment tools, such as CHADS2 score, CHA2DS2-VASc score, ESO guidance and NICE guidance, provides an objective method on deciding anticoagulation. Anticoagulation is associated with 1–2% major bleeding risk including cerebral haemorrhage which can be reduced with hypertension management. The use of the HAS-BLED score and individual case assessment also helps quantify bleeding risk.

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