Anticoagulation to prevent stroke in atrial fibrillation and its implications for managed care

The American Journal of Cardiology
D E Singer

Abstract

Nonrheumatic atrial fibrillation (AFib) is the most potent common risk factor for stroke, raising the risk of stroke 5-fold. Six randomized trials of anticoagulation in AFib consistently demonstrated a reduction in the risk of stroke by about two-thirds. In these trials, anticoagulation in AFib was quite safe. In contrast, randomized trials indicate that aspirin confers only a small reduction in risk of stroke, at best. Pooled data from the first set of randomized trials indicate that prior stroke, hypertension, diabetes, and increasing age are independent risk factors for future stroke with AFib. Individuals < 65 years old with none of the other risk factors might safely avoid anticoagulation; for all others, anticoagulation seems indicated. Studies of hemorrhagic risk highlight the importance of keeping the international normalized ratio (INR) < 4.0. Recent analyses also reveal that risk of ischemic stroke in AFib increases greatly at INR levels < 2.0. Efficacy and safety of anticoagulation in AFib depend on maintaining the INR between 2.0-3.0. Cost-effectiveness studies indicate that anticoagulation for AFib is among the most efficient preventive interventions in adults. Importantly, the benefits of anticoagulation in AFib a...Continue Reading

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Citations

Feb 28, 2002·Lancet·Nicholas S PetersVias Markides
Jul 2, 2002·The American Journal of Geriatric Cardiology·Albert L Waldo
Jul 12, 2005·Current Treatment Options in Cardiovascular Medicine·Edith A Nutescu, Cathy M Helgason
Nov 24, 1999·The American Journal of Cardiology·P JaïsJ Clémenty
Sep 15, 2015·Fitoterapia·Chuan-Pu ShenLing-Yi Kong
May 24, 2019·Expert Opinion on Drug Metabolism & Toxicology·Emmanouela Kampouraki, Farhad Kamali
Oct 3, 2002·Dimensions of Critical Care Nursing : DCCN·Linda Josephson, Maureen McMullen

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