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Anticoagulation in atrial fibrillation and flutter.
M F Scholten1, A S Thornton, J M Mekel
1Department of Clinical Electrophysiology, Thoraxcentre, Erasmus University Medical Centre, Rotterdam, The Netherlands. m.f.scholten@erasmusmc.nl
Summary
Atrial fibrillation and atrial flutter increase stroke risk. This review covers thromboembolism, risk assessment, and anticoagulation strategies, including around procedures like catheter ablation.
Area of Science:
- Cardiology
- Neurology
- Thrombosis Research
Background:
- Atrial fibrillation and atrial flutter are significant risk factors for ischemic stroke.
- Thromboembolism originating from the atria poses a major clinical challenge.
Purpose of the Study:
- To review the pathogenesis of thromboembolism in atrial arrhythmias.
- To discuss risk assessment and current anticoagulation strategies.
- To provide guidance on anticoagulation management around procedures like catheter ablation and cardioversion.
Main Methods:
- Comprehensive literature search on atrial fibrillation, atrial flutter, and stroke.
- Synthesis of evidence regarding thromboembolism pathogenesis and risk stratification.
- Analysis of anticoagulation efficacy and alternative therapies.
Main Results:
- Established link between atrial arrhythmias and increased stroke risk.
- Identified key factors for thromboembolic risk assessment.
- Evaluated efficacy of various anticoagulation therapies and alternatives.
- Highlighted complexities of anticoagulation around procedures.
Conclusions:
- Effective anticoagulation is crucial for stroke prevention in patients with atrial fibrillation and atrial flutter.
- Tailored anticoagulation strategies are necessary for procedures like catheter ablation and cardioversion.
- A suggested anticoagulation strategy for pulmonary vein ablation is proposed.