OBJECTIVES: The REACT AF study investigated the outcomes and management associated with stroke prevention treatments in patients with non-valvular atrial fibrillation (NVAF) in Europe. This analysis assessed 1) the use of oral anticoagulation drugs (OACs) and 2) whether current practice is consistent with the 2012 European Society of Cardiology (ESC) recommendations.   METHODS: We conducted an observational retrospective cohort study of patients with NVAF in the Longitudinal Patient Database (CEGEDIM) in France, Italy, UK, Spain and Germany. The analysis included patients >=18 years old, with AF diagnosis, and without rheumatic valvular disease or prosthetic valves. Patients had to be in the database for ≥1 year before date of 1st visit (index date) during the inclusion period (May 2010-April 2012). We calculated patients’ CHA2DS2-VASc score at index date for untreated patients and at the time of the current OAC initiation for treated patients. We evaluated patients’ requirement for stroke prevention therapy based on the 2012 ESC recommendations and calculated the percentage of patients for whom treatment initiation and OAC use were consistent with recommendations. RESULTS: In France 53% of the OAC patients (total=16,329) were treated consistently with the 2012 ESC recommendations (treatment requirement and choice of OAC); 46% in Germany (total=13,468), 58% in Spain (total=12,357); 39% in Italy (total=22,447); and 36% in the UK (total=19,956). The percentage of patients (CHA2DS2-Vasc>1, if not alone due to female gender) not receiving the required treatment (either not treated or treated with a non-recommended OAC) was 36% in France; 48% in Germany; 34% in Spain; 52% in Italy; and 48% in the UK. CONCLUSIONS: The study findings indicate there is a discrepancy between current practice regarding OAC prescribing and the 2012 ESC recommendations. Special attention must be given to time of treatment initiation and choice of OAC to correctly follow ESC recommendations.