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[Antithrombotic treatment of permanent atrial fibrillation]
1Service de cardiologie, Hôpital Central, Nancy.
Insights
Atrial fibrillation is a primary cause of arterial embolism, leading to stroke. Antithrombotic therapy, balancing bleeding risks, is crucial for preventing thromboembolic events in patients with atrial fibrillation.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Atrial fibrillation is the leading cause of arterial embolism.
- 30-35% of patients with arrhythmia experience ischemic cerebral accidents.
- Antithrombotic treatment is vital for preventing these accidents.
Purpose of the Study:
- To assess the value of systematic antithrombotic treatment in preventing cerebral accidents in patients with atrial fibrillation.
- To evaluate the benefits and risks of anticoagulant versus antiplatelet therapies.
Main Methods:
- Review of five randomized trials on antithrombotic treatment for atrial fibrillation.
- Case-by-case analysis of patient risk factors and treatment benefits.
Main Results:
- Systematic antithrombotic treatment significantly reduces thromboembolic accidents and mortality.
- The risk of hemorrhage varies and must be carefully evaluated.
- Treatment choice depends on balancing expected benefits against potential risks.
Conclusions:
- Anticoagulants are essential for atrial fibrillation in cardiac valve disease.
- Idiopathic atrial fibrillation in younger patients may warrant therapeutic abstention or antiplatelet drugs.
- A personalized approach is necessary to optimize antithrombotic therapy for atrial fibrillation.
Abstract:
Whether idiopathic or associated with an underlying heart disease, complete arrhythmia induced by atrial fibrillation ranks first among the causes of arterial embolism. It has been recognized that 30 to 35% of subjects with arrhythmia develop a transient or permanent ischaemic cerebral accident, and it is therefore rational to assess the value of systematic antithrombotic treatment in the prevention of such accidents. It is agreed by all that anticoagulants are necessary when atrial fibrillation occurs in the course of cardiac valve diseases, notably those of rheumatismal origin. Conversely, the idiopathic complete arrhythmia, which usually occurs in subjects aged below 60, calls for either therapeutic abstention or prescription of antiplatelet drugs. In all other cases, five randomized trials can be used as reference. They all show that thromboembolic accidents and mortality can be reduced and favour a systematic preventive treatment. The risk of haemorrhage has been diversely evaluated in these five trials. The choice between anticoagulant and antiplatelet therapies therefore rests on a case by case analysis aimed at balancing in each patient the benefits expected against the possible risks.