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
References
Oct 1, 1978·Neurology·P A WolfW B Kannel
Nov 12, 1992·The New England Journal of Medicine·M D EzekowitzM J Radford
Dec 12, 1992·BMJ : British Medical Journal·C GustafssonL A Marké
Apr 1, 1992·Medical Decision Making : an International Journal of the Society for Medical Decision Making·D L KentS D Fihn
Jun 1, 1992·Annals of Internal Medicine·J H GurwitzJ Ansell
Aug 1, 1991·Stroke; a Journal of Cerebral Circulation·P A WolfW B Kannel
Nov 29, 1990·The New England Journal of Medicine·UNKNOWN Boston Area Anticoagulation Trial for Atrial Fibrillation InvestigatorsJ Philip Kistler
Dec 30, 1982·The New England Journal of Medicine·R HullP Ockelford
Nov 13, 1995·Archives of Internal Medicine·J E AnsellL Fish
Jul 6, 1995·The New England Journal of Medicine·S C CannegieterE Briët
Feb 13, 1995·Archives of Internal Medicine·D C McCroryE L Pritchett
Sep 1, 1993·Annals of Epidemiology·D E Singer
Jun 1, 1994·Annals of Internal Medicine·E M Hylek, D E Singer
Aug 22, 1996·The New England Journal of Medicine·E M HylekD E Singer
Dec 9, 1996·Archives of Internal Medicine·R S Stafford, D E Singer
Jan 1, 1993·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·UNKNOWN Stroke Prevention in Atrial Fibrillation Investigators
Citations
Feb 28, 2002·Lancet·Nicholas S PetersVias Markides
Jan 18, 2002·Heart·M NakamuraK Hiramori
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
Dec 15, 2004·Chest·Matthew W ReynoldsLuba Nalysnyk
Jun 22, 2017·Expert Review of Clinical Pharmacology·Emmanouela Kampouraki, Farhad Kamali
May 24, 2019·Expert Opinion on Drug Metabolism & Toxicology·Emmanouela Kampouraki, Farhad Kamali
Mar 7, 2012·Expert Review of Cardiovascular Therapy·Mahboob AlamNasser Lakkis
Oct 3, 2002·Dimensions of Critical Care Nursing : DCCN·Linda Josephson, Maureen McMullen