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[Antithrombotic therapy for stroke prevention in patients with atrial fibrillation]
F Tomita1, T Kohya, A Kitabatake
1Department of Cardiovascular Medicine, Hokkaido University School of Medicine.
Insights
Atrial fibrillation (AF) increases stroke risk, especially in patients with prior stroke. Warfarin is recommended for high-risk AF patients, while aspirin suits those with low stroke risk or contraindications to warfarin.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Context:
- Atrial fibrillation (AF) is a prevalent cardiac arrhythmia.
- AF is a significant independent risk factor for cerebrovascular events (stroke).
- Stroke risk in AF patients varies based on comorbidities like hypertension, diabetes, and prior stroke/TIA.
Purpose:
- To summarize the stroke risk associated with atrial fibrillation.
- To evaluate the efficacy and safety of anticoagulation therapies for stroke prevention in AF patients.
- To provide guidance on selecting appropriate antithrombotic agents based on individual patient risk.
Summary:
- The overall annual stroke risk in AF patients is approximately 5%, escalating to 12% in those with a history of stroke or TIA.
- Adjusted-dose warfarin (target INR 2.0-3.0) demonstrates high efficacy and safety for stroke prevention in selected AF patients.
- Aspirin offers a modest stroke risk reduction and is an alternative for low-risk patients or those unable to take warfarin.
Impact:
- Informs clinical decision-making for stroke risk stratification in AF patients.
- Highlights the importance of tailored antithrombotic therapy selection.
- Aims to reduce the incidence of stroke and improve outcomes in the AF population.
Abstract:
Atrial fibrillation(AF) is a common arrhythmia that is an important independent risk factor for stroke. The overall risk of stroke in AF patients averages about 5%/y, but with wide variation depending on the presence of coexistent thromboembolic risk factors, which include increasing age, history of hypertension, previous stroke or transient ischemic attack(TIA), and diabetes. AF patients with prior stroke or TIA are at highest risk(about 12%/y). Adjusted-dose warfarin(target INR 2.0-3.0) is highly efficacious for preventing stroke in AF patients, and is safe for selected patients. Aspirin has a modest effect on reducing stroke. Warfarin is recommended for high-risk AF patients who can safely receive it. Aspirin may be indicated for those with a low stroke risk and for those who cannot receive warfarin.