Protecting individuals from AF-related stroke through the initiation of anticoagulation therapy is a national priority.

Despite the availability of vitamin K antagonist oral anticoagulants and direct oral anticoagulants (DOAC), people are still experiencing preventable AF-related strokes due to failure to prescribe these protective medications.

The consequences of not treating patients with known AF at risk of stroke with protective anticoagulant therapy can be devastating. For example, in England in 2016/17 there were 15,785 strokes in people with known AF prior to hospital admission; of these 7,483 were not prescribed anticoagulant therapy at the time of their stroke. The outcome for many of these untreated AF patients was poor, with 26% dying and a further 45% left with moderate to severe disability. Based on QOF 2018/19, in England there are 142,930 people with AF at risk of stroke who are not prescribed anticoagulant therapy. Stroke

Stroke risk assessment using CHADS2VASc should be embedded in local guidance, alongside an assessment of bleeding risk with identification of modifiable risk factors. Anticoagulation therapy, in the form of warfarin or a DOAC must be initiated in a timely manner. This section of the toolkit brings together guidelines, tools and case studies to assist local areas in addressing unmet need in the Protect area of AF care.