HEART REVIEW

Antithrombotic treatment in atrial fibrillation

G Y H Lip, C J Boos

Haemostasis, Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK

Correspondence to:
Professor Gregory Y H Lip
Haemostasis, Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham B18 7QH, UK; g.y.h.lip{at}bham.ac.uk

Atrial fibrillation (AF) is the most common sustained arrhythmia, that substantially increases morbidity and mortality. AF is gaining in clinical and economic importance, with stroke and thromboembolism being major complications. In this article, the evidence for AF treatment trial of antithrombotic therapy is reviewed. Stroke risk stratification of patients with AF is discussed, and practical recommendations for thromboprophylaxis are presented.

Abbreviations: ACTIVE, atrial fibrillation clopidogrel trial with irbesartan for the prevention of vascular events; AF, atrial fibrillation; AFASAK, Copenhagen atrial fibrillation, aspirin, and anticoagulation study; AFFIRM, atrial fibrillation follow up investigation of rhythm management; AMADEUS, atrial fibrillation trial of monitored, adjusted dose vitamin K antagonist, comparing efficacy and safety with unadjusted SanOrg 34006/idraparinux; BAFTA, Birmingham atrial fibrillation treatment of the aged; CHADS₂, recent congestive heart failure, hypertension, age, diabetes mellitus, history of stroke or transient ischaemic attack; CI, confidence interval; EAFT, European atrial fibrillation trial; ESPS, European stroke prevention study; FFAACS, fluindione, fibrillation auriculaire, aspirin et contraste spontané; INR, international normalised ratio; MATCH, management of atherothrombosis with clopidogrel in high risk patients with recent transient ischaemic attack or ischaemic stroke; MIWAF, minidose warfarin in atrial fibrillation; NASPEAF, national study for primary prevention of embolism in non-rheumatic atrial fibrillation; NNT, number needed to treat; PATAF, primary prevention of arterial thromboembolism in non-rheumatic atrial fibrillation; RR, relative risk; RRR, relative risk reduction; SIFA, studio Italiano fibrillazione atriale; SPAF, stroke prevention in atrial fibrillation; SPORTIF, stroke prevention using the oral thrombin inhibitor in patients with non-valvar atrial fibrillation; VKA, vitamin K antagonists

Keywords: atrial fibrillation; stroke; anticoagulation; warfarin; aspirin

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