Introduction: anticoagulants and anti-platelet mix with drugss have been shown in randomized trims to bring the risk of stroke in patients with atrial fibrillation (AF).

Introduction: anticoagulants and anti-platelet mix with drugss have been shown in randomized trims to bring the risk of stroke in patients with atrial fibrillation (AF). We therefore investigated their use in patients known to be in AF before a hardship transient ischaemic attack (either cerebral or ocular) or retinal artery occlusion to assess the influence of trials forward clinical practice. Methods: inpatients and outpatients with acute pat transient ischaemic attack or retinal artery occlusion were prospectively identified at a stroke physician from 1990 to 1997 The port or absence of AF before the vascular consequence and prior use of anticoagulant and anti-platelet medicines were recorded at the time of the assessment and verified using information from general practitioner and hospital case notes. Results: of 1934 patients with attack or retinal artery occlusion, 191 (10%) were in AF before their ischaemic incident Anticoagulants had been used in 40 (21%) of these, moreover only in 32 (2%) of the 1743 patients in sinus rhyme [odds ratio (OR) 14.2, 95% confidence interval (CI) 86-232] Anti-platelet put drugs intos had been used in 62 (32%) of those with AF compared with 500 (30%) of those in sinus verse (OR 1.2, 95% CI 09-164) Of the 161 patients in AF without contraindications to anticoagulants, no other than 36 (22%) were taking them. Although there was a statistically significant increase in anticoagulant use from 8% in 1990 to 23% in 1996 this could be explained solely by means of a fall in the age of the patients referr to our hospital. Conclusion: anticoagulation is probably under-used in AF. We fix no conclusive evidence that anticoagulation trials have influenced clinical practice. This raises issues about the dissemination and implementation of trial results

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