We aimed to explore the temporal trends of atrial fibrillation (AF) and/or rheumatic heart disease (RHD)-related ischemic stroke patients, anticoagulation use and factors related to suboptimal use of anticoagulants in Chinese population.

Underuse of anticoagulants in ischemic stroke patients with AF and/or RHD is a global issue, especially in China. However, the accurate knowledge of secular trends of anticoagulants use in AF and/or RHD-related ischemic stroke patients is limited in China.

Of 4357 acute ischemic stroke patients (≤7 days after onset) included during 2010-2017, 823(18.9%) were AF and/or RHD-related. Among all the AF and/or RHD-ischemic stroke patients, there was an increase in the proportion of previously known AF patients (from 38.1% to 59.8%, P for trend<0.001), followed by a reduction in the proportion of newly diagnosed AF in hospital (from 51.1% to 32.8%, P for trend=0.001). During the same period, both previously known and newly diagnosed RHD-patients decreased with time (all P for trend≤0.03). There was an increase in the proportion of AF and/or RHD patients who were prescribed anticoagulants at discharge (from 26.4% to 45.1%, P for trend<0.001), while the proportion of AF and/or RHD patients with antiplatelet therapy reduced with time (from 56.0% to 30.0%, P for trend<0.001). Despite that, non-vitamin K antagonist oral anticoagulants (NOAC) use at discharge were still low during the study period (2.1%).