Prevention of cardioembolic stroke: use of oral anticoagulants in patients with atrial fibrillation.

With the aim of quantifying the use of oral anticoagulant (OA) therapy in clinical practice, we surveyed 150 consecutive patients admitted with a diagnosis of atrial fibrillation (AF). Each patient was administered a questionnaire relating to the classic vascular risk factors and to the antithrombotic treatment received at home. The diagnosis of AF was formulated at the time of admission in 45 cases. Of the 105 cases with a previous diagnosis, OA therapy was relatively or absolutely contraindicated in 21 patients (20%), whereas the other 84 (80%) were ideal candidates for the treatment. Of these, 20 (24%) were actually receiving OA, 16 (19%) were on platelet anti-aggregants (PA), and 48 (57%) were receiving no antithrombotic treatment at all. Even lower percentages of OA use were found in the patients with a previous (20%) or recent (16%) history of cerebral ischemia. Upon discharge, of the 115 patients without contraindications to OA (84 with previously known and 31 with newly diagnosed AF), 50% were receiving OA and 20% PA. The results of this survey show that OA therapy is little used in the Valle d'Aosta Region for the prevention of ischemic stroke in AF patients at high risk for cerebral ischemia. The lack of knowledge among the general population, the difficulty of initiating the therapy in patients such as ours with severe comorbidities, and the absence of disorganization of centers for OA monitoring may be the main reasons underlying this low level of use. Population screening or a sensitization campaign could increase the identification of subjects at risk, whereas better organization of coagulation monitoring centers could encourage OA use in subjects at high risk for cerebral ischemia.

Epidemiology of primary intracranial tumors in the Valle d'Aosta (Italy) during the 6-year period 1986-1991.

A total of 285 new cases of primary intracranial tumors (PIT: 178 cases, 62%) and secondary forms (107 cases, 38%) were detected by CT scan and MRI during a population-based study of the incidence rates of these neoplasms in the Aosta Valley (N.W. Italy: 114,325 residents in 1988) during the period 1986-1991. The PIT are discussed in this paper. Histological confirmation was obtained in 60%. Age- and sex-adjusted mean annual incidence rate for all PIT was 28.3/100,000 (men 21.7; women 28.1). The incidence rates by types were 9.7 for meningiomas (men 5.3; women 13.9), 9.1 for tumors of the neuroepithelial group (men 10; women 8.1), 3.7 for adenomas (men 2.6; women 4.6), and 1.9 for neurinomas (men 2.9; women 0.9). Incidence rate increased with age. Meningiomas comprised 37% of the PIT, followed by tumors of the neuroepithelial group (35%), adenomas (14%, neurinomas (7.3%) and malignant lymphomas (2.3%). The remaining subtypes were 4.6%. Our data showed a clearly higher incidence rate than in previous population-based surveys. The differences were most marked in the meningioma group. The extensive use of CT scan and the more intensive case-finding could explain the differences.

Incidence and prognosis of stroke in the Valle d'Aosta, Italy. First-year results of a community-based study.

BACKGROUND AND PURPOSE: We sought to determine the incidence rate, risk factors, and prognosis of stroke in Valle d'Aosta, Italy, to provide information for planning regional health-care facilities. METHODS: We undertook a prospective study of all new cases of stroke in the geographically defined population of 114,325 residents of Valle d'Aosta in northern Italy. RESULTS: In the first year of the study (January 1-December 31, 1989), 254 cases of first stroke were registered. The crude annual incidence rate was 2.23/1,000, 1.98/1,000 for men and 2.46/1,000 for women. After adjustment to the 1988 Italian population, the incidence rate for first stroke was 2.15/1,000 per year, 2.48/1,000 per year for men and 1.99/1,000 per year for women. The pathological diagnosis was cerebral infarction in 67%, intracranial hemorrhage in 15%, and unknown in 18%. The overall 30-day case-fatality rate was 31%. In survivors, Barthel Index Score recorded at 30 days from stroke onset showed that 100 patients (62%) were dependent in activities of daily living. CONCLUSIONS: Our results do not differ significantly from those reported in Umbria, the only similar study performed in Italy, and support non-Italian data as to risk factors in stroke.