[Reasons for underuse of oral anticoagulation in atrial fibrillation-associated stroke: prospective study of German stroke patients].

Oral anticoagulation in atrial fibrillation (AF) is effective in primary and secondary prevention of cardioembolic stroke, but is often underused in practice. The detailed reasons for non-use of oral anticoagulation are less well known. We prospectively analyzed 105 consecutive cases of acute ischemic stroke associated with atrial fibrillation. Patients were investigated by a semi-structured interview. The most frequent reasons for underuse were: unknown AF (43 %). In case of known AF: reluctance of patients (30 %), contraindications (25 %) and compliance problems (20 %). There was good agreement between patients and physicians views about nonuse or aborted use of oral anticoagulation (kappa 0.64 and 0.93, respectively). Unknown atrial fibrillation is the most prevalent cause of underutilization of oral anticoagulation in acute stroke patients. Since atrial fibrillation is easy to detect in most cases, it could be worthwhile to screen elderly patients without contraindications for anticoagulation.