[Anticoagulation therapy in paroxysmal atrial fibrillation]

Patients with paroxysmal atrial fibrillation have a risk of thromboembolic complications probably equivalent to those with permanent atrial fibrillation. Patients with a previous cerebral infarction, hypertension, age above 65, diabetes, previous myocardial infarction, reduced left ventricular function, heart failure or enlarged left atrium with or without a visible thrombus are especially prone to thromboembolic complications. International guidelines recommend anticoagulation therapy with warfarin to INR levels between 2.0-3.0 for the majority of patients with atrial fibrillation. Acetylsalicylic acid provides inferior protection and can only be recommended for a selected subpopulation of patients. Patients with atrial fibrillation who convert spontaneously or after medical or electrical treatment, should have low molecular weight heparin administered prior to conversion and warfarin for at least four weeks after successful conversion. The rationale for choosing a treatment strategy in conflict with recommended guidelines should appear in writing in the patient's file in any individual case.