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Antithrombotic Therapy in Atrial Fibrillation
Section snippets
RISK OF STROKE WITH ATRIAL FIBRILLATION
The stroke rate of patients with AF is, on average, approximately six times the stroke risk of people without AF.2,9 The relative risk is even higher (about 15) in patients who have AF and mitral stenosis. However, the absolute annual risk of stroke is similar in the two groups because the patients with mitral stenosis tend to be younger and have fewer concomitant diseases.9 The risk of stroke also varies greatly depending upon age and coexisting cardiovascular disease. Patients younger than 60
EFFICACY OF ANTITHROMBOTIC THERAPY IN ATRIAL FIBRILLATION
Six studies assessing antithrombotic therapy as primary prevention in AF have recently been published. These are the Atrial Fibrillation, Aspirin, Anticoagulation Study from Copenhagen, Denmark (AFASAK),12 the Stroke Prevention in Atrial Fibrillation study from the United States (SPAF),13 the Boston Area Anticoagulation Trial for Atrial Fibrillation (BAATAF),14 the Canadian Atrial Fibrillation Anticoagulation Study (CAFA),15 the Stroke Prevention in Non-rheumatic Atrial Fibrillation Study from
ANTICOAGULATION FOR ELECTIVE CARDIOVERSION
Synchronized capacitor discharge was introduced by Lown and coworkers31 for the rapid termination of atrial and ventricular tachyarrhythmias. Systemic embolism is the most serious complication of cardioversion and is also a complication of pharmacologic cardioversion. The precise incidence of embolism following cardioversion is not known. Many unstudied variables may be predictors of embolization following cardioversion including age, sex, underlying disease, atrial size, duration of
RECOMMENDATIONS
It is recommended that long-term oral anticoagulant therapy (INR 2.0 to 3.0) be strongly considered for all patients older than 65 with AF, and for patients younger than 65 who have any of the following risk factors: a previous TIA or stroke, hypertension, heart failure, diabetes, clinical coronary artery disease, mitral stenosis, prosthetic heart valves, or thyrotoxicosis. This is a grade A recommendation based on level I+ evidence from a pooled analysis of five randomized primary prevention
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