Stroke and Thromboembolism in Atrial Fibrillation

Abstract

We performed a systematic review of the available evidence on the relationship between the individual clinical, echocardiographic and laboratory characteristics of patients with atrial fibrillation (AF) and the risk of stroke. A systematic review was also performed of all published stroke risk stratification models, as well as the accuracy of their discriminative ability between risk strata. Third, we reviewed the literature on cost-effectiveness analyses with oral anticoagulation in AF. From the systematic review on stroke risk factors, a prior stroke or transient ischemic attack (15/16 studies positive, risk ratio [RR] 2.86), hypertension (11/20 studies positive, RR 2.27), aging (9/13 studies positive, RR 1.46 per decade increase), structural heart disease (9/13 studies positive, RR 2.0) and diabetes (9/14 studies positive, RR 1.62) were found to be good independent predictors of stroke. Supportive evidence was found for sex (8/22 studies positive, RR 1.67), vascular disease (6/17 studies positive, RR 2.61) and heart failure (7/18 studies positive, RR 1.85). The various risk stratification schemes classified variable proportions as low, moderate and high risk, but the CHA2DS2-VASc score classified the smallest proportion of patients as 'low risk'. Anticoagulation with vitamin K antagonists and dabigatran is cost-effective in patients at high risk of stroke, but not in patients without any other stroke risk factor beside AF. Continued efforts are warranted to improve the antithrombotic management of AF patients to identify, and challenge, risk factors and refine risk stratification models in order to realize an individualized tailored, risk factor-based approach.

Modification of Outcomes With Aspirin or Apixaban in Relation to CHADS 2 and CHA 2 DS 2 -VASc Scores in Patients With Atrial Fibrillation

“…In this contemporary clinical trial cohort, significant predictors of stroke on aspirin were age, prior stroke/TIA, creatinine clearance, and nonparoxysmal AF on multivariate analysis, which is largely consistent with the literature for age, prior stroke, and creatinine clearance. 21 There were no significant univariate predictors of stroke risk among the apixaban-treated patients, although body mass index was a predictor on multivariate analysis.…”

Application of anticoagulant therapy in patients undergoes the procedure radiofrequency catheter ablation

“…Пациенты с ФП имеют повышенный риск тромбоэмболических осложнений, который за-висит от наличия факторов риска тромбоза ле-вого предсердия во время пароксизма фибрил-ляции [5,6]. Кроме того, сама катетерная проце-дура у этих больных увеличивает риск тромбоэмболических осложнений за счет поста- новки одного и более интродьюсеров в одну ве-ну, использования длинных шифтов-интродью-серов с фиксацией их в левом предсердии.…”

Prevention and treatment of ischemic stroke in patients with atrial fibrillation

“…A systematic review of the evidence on the relationship between the individual clinical, echocardiographic and laboratory characteristics of AF patients and the risk of IS demonstrates the following good independent predictors of IS: a prior IS or TIA (15/16 positive studies, risk ratio (RR) 2,86), AH (11/20 positive studies, RR 2,27), aging (9/13 positive studies, RR 1,46 per decade increase), structural heart disease (9/13 positive studies, RR 2,0) and diabetes mellitus (9/14 positive studies, RR 1,62) (33).…”