Antithrombotic Therapy in Atrial Fibrillation

Laupacis, Andreas; Albers, Gregory W.; Dunn, Marvin; Feinberg, William M.

doi:10.1378/chest.102.4_supplement.426s

Cited by 213 publications

(135 citation statements)

References 76 publications

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“…Several large prospective trials and meta-analyses have demonstrated warfarin superioritycompared to aspirin therapy in reducing stroke for high-risk AF patients [47][48][49][50][51][52][53][54][55][56][57][58][59][60]. Review of data comparing warfarin to anti-platelet agents will not be reiterated here, but references are provided to the reader [47][48][49][50][51][52][53][54][55][56][57][58][59][60][61].…”

Section: Anti-platelet Versus Anti-coagulation Therapy For Af Stroke mentioning

confidence: 99%

“…Review of data comparing warfarin to anti-platelet agents will not be reiterated here, but references are provided to the reader [47][48][49][50][51][52][53][54][55][56][57][58][59][60][61]. Generally speaking, the optimal therapy for each patient is individualized based on ischemic stroke risk factors against hemorrhage risks, such as prior intracranial hemorrhage or gastrointestinal bleeding.…”

Section: Anti-platelet Versus Anti-coagulation Therapy For Af Stroke mentioning

confidence: 99%

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Prevention of Cardioembolic Stroke

Freeman

Aguilar

2011

Neurotherapeutics

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Cardiac causes of ischemic stroke lead to severe neurological deficits from large intracranial artery occlusion compared to small vessel ischemic stroke. The most common cause of cardioembolic stroke is atrial fibrillation (AF), which has an increasing incidence with age. AF stroke trials demonstrate that anti-coagulation is superior to anti-platelet therapy in terms of ischemic stroke prevention. Recently, warfarin was compared with dabigatran, an oral, direct thrombin inhibitor, and was found to be at least equally effective in reducing ischemic stroke with less intracranial bleeding risk. Future research is investigating other direct thrombin inhibitors as potential alternatives to warfarin, which has a narrow therapeutic index, requires frequent blood monitoring, has multiple drug interactions, and a higher rate of intracranial bleeding. Other causes of cardioembolic stroke include myocardial infarction, left ventricular thrombus, reduced ejection fraction, valvular abnormalities, and endocarditis. Patent foramen ovale is a common finding on echocardiograms in patients with and without stroke (up to 20% of the population), and it is a controversial source of cryptogenic stroke. The best way to prevent cardioembolic stroke remains early detection and treatment of AF, and treating the underlying stroke mechanism. Cardiac magnetic resonance imaging is an emerging technology and reveals some sources of cardiac embolism missed by echocardiography, and might provide an additional diagnostic tool in investigating cardioembolic stroke.

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Section: Anti-platelet Versus Anti-coagulation Therapy For Af Stroke mentioning

confidence: 99%

Section: Anti-platelet Versus Anti-coagulation Therapy For Af Stroke mentioning

confidence: 99%

Prevention of Cardioembolic Stroke

Freeman

Aguilar

2011

Neurotherapeutics

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“…5,35 Associated factors that increase risk in patients with AF include older age, prior TIA or stroke, hypertension, impaired left ventricular function, and diabetes mellitus. 35,48 Atrial fibrillation is implicated in approximately 23.5% of strokes in patients between the ages of 80 and 89 years. 47 Atherosclerosis of the carotid arteries is implicated in 20 to 30% of ischemic strokes.…”

Section: Cardiovascular-associated Risk Factorsmentioning

confidence: 99%

Epidemiology of transient ischemic attack and ischemic stroke in patients with underlying cardiovascular disease

Gorelick

2004

Clin Cardiol

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Summary:It is estimated that 15 to 30% of ischemic strokes are cardioembolic in origin, and that atrial fibrillation, valvular heart disease, coronary artery disease, congestive heart failure, and myocardial infarction are significant risk factors for stroke, which underscores the importance for cardiologists to understand this condition. The high incidence and substantial cost of stroke justify aggressive treatment of stroke risk factors, especially in the elderly, diabetic, and black populations, and in patients who have had an initial stroke. Antiplatelet therapy and administration of oral anticoagulants have both been shown to have a substantial impact on stroke in specified populations at risk.

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“…Several randomized controlled trials have demonstrated the efficacy of warfarin in preventing a first stroke among patients with nonvalvular AF, with RR reductions ranging from 42 to 86%. [40][41][42] The Stroke Prevention in Atrial Fibrillation study (SPAF I) demonstrated a benefit of aspirin (325 mg daily) versus placebo in reducing the risk of stroke associated with AF. 41 In contrast, other trials using 75 mg of aspirin-Atrial Fibrillation, Aspirin, AntiKoagulation (AFASAK), 42 300 mg aspirinEuropean Atrial Fibrillation Trial (EAFT), 43 or 325 mg aspirin plus minidose warfarin (SPAF III) 44 failed to demonstrate significant benefit.…”

Section: Trials Of Anticoagulant Therapiesmentioning

confidence: 99%

“…[40][41][42] The Stroke Prevention in Atrial Fibrillation study (SPAF I) demonstrated a benefit of aspirin (325 mg daily) versus placebo in reducing the risk of stroke associated with AF. 41 In contrast, other trials using 75 mg of aspirin-Atrial Fibrillation, Aspirin, AntiKoagulation (AFASAK), 42 300 mg aspirinEuropean Atrial Fibrillation Trial (EAFT), 43 or 325 mg aspirin plus minidose warfarin (SPAF III) 44 failed to demonstrate significant benefit. For most patients in these trials, warfarin use in conjunction with AF was safe, with an annual rate of 1.3% for major bleeding, compared with 1% in patients on placebo or aspirin.…”

Section: Trials Of Anticoagulant Therapiesmentioning

confidence: 99%

Secondary stroke prevention: Review of clinical trials

Elkind

2004

Clin Cardiol

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Summary:Patients who experience a stroke or transient ischemic attack (TIA) are at high risk for subsequent vascular events, most commonly stroke. This article focuses on clinical trials examining secondary prevention of stroke and reviews the various commonly used methods of stroke prevention: surgical approaches, antihypertensive treatment, lipid-and cholesterol-lowering medications, anticoagulant therapies, and antiplatelet therapies.

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Antithrombotic Therapy in Atrial Fibrillation

Cited by 213 publications

References 76 publications

Prevention of Cardioembolic Stroke

Prevention of Cardioembolic Stroke

Epidemiology of transient ischemic attack and ischemic stroke in patients with underlying cardiovascular disease

Secondary stroke prevention: Review of clinical trials

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