Atrial Fibrillation as a Cause of Stroke and Intracranial Hemorrhage Study (The FibStroke Study)
Atrial Fibrillation as a Cause of Stroke and Intracranial Hemorrhage Study (The FibStroke Study)
The aim of this study is to evaluate the role of atrial fibrillation (AF) and its treatment
 in relation to thromboembolic events (stroke, and transient ischemic attacks) and
 intracranial hemorrhage.

 Primary Outcome Measures:

 - Incidence and timing of intracranial complications (stroke,TIA, bleedings) in relation to
 diagnosis and anticoagulation treatment of AF during the study period; comparison of
 complications between those with and without anticoagulation treatment according to CHADSVASc
 score.

 Secondary Outcome Measures:

 -  The effect of anticoagulation pauses and INR level on stroke and bleeding risk; strokes
 within 30 days after anticoagulation pause and the prevalence of stroke and intracranila
 bleeding in relation to INR level < 2, 2-3 and >3.

 -  Trauma as a risk factor for intracranial bleeding: percentage and risk factors for
 intracranial bleeding with or without trauma. Type of preceding trauma and type of
 intracranial bleeding.

 -  The time relation between diagnosis of AF and type of intracranial complications: Kaplan
 Meier analysis of thrombotic (Stroke/TIA) and intracranial bleeding complications after
 1st diagnosis of AF in patients with and without anticoagulation

 -  The risk of stroke and intracranial bleeding in relation to CHADSVASc score, HAS-BLED
 score and anticoagulation/antithrombotic treatment

 -  Prognosis of stroke and intracranial bleeding: 30-day mortality after stroke and
 intracerebral bleeding in patients with and without anticoagulation

 -  Factors related to underuse of anticoagulation treatment. Data on reasons for not
 starting or stopping aticoagulation in those with indication of oral anticoagulation

 -  Operations and procedure as risk factor for stroke: Frequency and type of operations
 performed < 30 days before stroke. Data on length of perioperative pause in
 anticoagulation and use of bridging therapy and timiing of stroke are collected.

 -  Cardioversions as a risk factor for stroke: Frequency of stroke and TIA < 30 days after
 cardioversion in relation to use of anticoagulation and CHADSVASc score

 -  The risk of stroke and intracranial bleeding in relation to type of AF (permanent,
 persistent, paroxysmal) and concomitant carotid disease

 Estimated Enrollment: 6000 patients.
Approximately 20% of stroke is caused by atrial fibrillation (AF) and 1% of patients with AF
 suffer from intracranial hemorrhage. Thus, the net benefit of AF management is the key factor
 in choosing the successful treatment (pharmacological and interventional).

 In this retrospective Finnish multicenter study the investigators collect data on patients
 with intracranial thromboembolic events or intracranial hemorrhage and AF during the study
 period. All such patients ≥18 years of age are identified and relevant clinical details are
 retrospectively gathered from the hospital records of the participating hospitals into an
 internet-based CRF. The total study period is from 2003 to 2012.

 All case records are reviewed using standardized data collection protocol to get information
 on baseline characteristics and medication of the patients, management of the patients before
 and during the index complication and during a 30-day follow-up after each complication.

 Diagnosis of atrial fibrillation is based 12-lead electrocardiography according to the
 standard criteria.

 Stroke is documented clinically and confirmed by computerized tomography or magnetic
 resonance imaging to be caused by cerebral infarction. Diagnosis of transient ischemic
 attacks are based on clinical diagnosis by neurologist when stroke is not confirmed by
 imaging. After completion of manual registration of data, a computer-based cross-checking of
 strokes is performed from discharge register data of the included patients to ensure the
 complete coverage of all events. Diagnosis of inctracranial bleedings are based on patient
 record and classified as subdural, subarachnoidal and intracerebral and possible preceding
 trauma is registered. Outcome measures are classified by study neurologist when necessary.

 Antigoagulation treatment, INR levels during the index complication, possible pauses in
 treatment and their casues are registered togethr with information on antiplatelet
 treatments.
Inclusion Criteria:

 -  All patients aged 18 or over, hospitalized or having emergency unit visit during the
 study period because of thromboembolic event (stroke, TIA) or intracranial hemorrhage
 and having the diagnosis of atrial fibrillation.

 Exclusion Criteria:

 -