Stroke prevention in patients with non-valvular atrial fibrillation: a current community perspective.

Non-valvular atrial fibrillation (NVAF) is responsible for up to 10% of all ischaemic strokes. The risk of stroke in these patients is substantial, particularly when associated with past cerebral ischaemia, hypertension, diabetes and age over 65. Warfarin has recently been shown to reduce this risk by two-thirds with relative safety. The files of 103 patients with chronic NVAF on recent presentation to hospital were studied to see if they had been given warfarin beforehand. Two-thirds would have been ideal candidates, having at least one added risk factor for stroke, and no contraindication for the use of warfarin. Yet fewer than 10% were taking it. Sixteen of these 103 patients had an ischaemic event at presentation, mostly stroke. Twelve were ideal candidates for warfarin prophylaxis, but none had received it for this purpose. Much more must be done to prevent stroke in these patients.