Atrial fibrillation and stroke risk prevention in real-life clinical practice

Guideline adherence in antithrombotic treatment after concomitant ablation surgery in atrial fibrillation patients

“…In addition, the appropriate treatment is further hampered by the introduction of different stroke risk stratification models in clinical practice which, although widely applied, have shown a suboptimal predictive value leading to misclassification of the individual patient risk, as shown recently for the CHADS 2 scheme [15,16]. These have undoubtedly led to some physicians being reluctant to prescribe OAC only on the basis of these risk-score schemes.…”

“…Finally, our patients were classified only on the basis of their CHADS 2 which it has been shown to have a limited efficacy for the prediction of peripheral thromboembolism in AF [24,25] and to lead to misclassification of the individual patient risk [15,16]. Consequently, its appropriateness and accurateness are still uncertain and this must be taken into account when examining our findings.…”

Stroke and Dementia in Atrial Fibrillation

“…(Nieuwlaat et al, 2007) However, the type of AF should not be taken into consideration, given that paroxysmal AF has a similar stroke risk to persistent or permanent AF in the presence of risk factors -therefore such patients would derive much benefit from anticoagulation prescription. (Tay et al, 2009) The National Acute Israeli Stroke Survey (NASIS) examined the potential effect of preadmission anticoagulation on stroke severity and outcome in patients with AF. Data showed that effective anticoagulation therapy is associated with decreased stroke severity, improved functional outcome, and better survival in patients with AF admitted with acute brain ischemia.…”

Contra: “Anti-platelet therapy is an alternative to oral anticoagulation for atrial fibrillation”

“…The ACTIVE investigators themselves have shown that those patients on warfarin with INR values within the therapeutic range are those that actually benefit from anticoagulation therapy (15). A real challenge of a health care system is to create the primary care facilities that will ensure close monitoring and guidance of patients on anticoagulation (16). A revolution in thromboembolism prevention is to be expected from novel new oral anticoagulants (17).…”