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Related Experiment Videos

Anticoagulation and atrial fibrillation

J E Atwood1, G W Albers

  • 1Cardiology Section, Palo Alto VA Medical Center, CA.

Herz
|February 1, 1993
PubMed
Summary

Low-dose warfarin significantly reduces stroke risk in atrial fibrillation (AF) patients. Anticoagulation is recommended for most AF patients, except young individuals with lone AF.

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Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Atrial fibrillation (AF) management involves balancing embolic and hemorrhagic risks.
  • Improved International Normalized Ratio (INR) monitoring and low-dose warfarin (INR 2.0-3.0) efficacy have clarified anticoagulation's role in AF.

Purpose of the Study:

  • To review evidence on anticoagulation therapy for atrial fibrillation.
  • To identify patient subgroups at high risk for embolic events.

Main Methods:

  • Analysis of five large prospective randomized trials in nonvalvular atrial fibrillation (NVAF).
  • Review of previous studies on anticoagulation and aspirin in AF.

Main Results:

  • Low-dose warfarin significantly reduces stroke risk in NVAF patients.
  • High-risk subgroups for embolism include those with hypertension, prior embolic events, structural heart disease, and older age.
  • Lone AF patients have low embolic rates and do not require anticoagulation.

Conclusions:

  • Anticoagulation is the treatment of choice for most AF patients, including those with rheumatic valvular disease, prosthetic valve disease, and NVAF.
  • Aspirin offers less benefit than warfarin but is an alternative for low-risk patients or those unsuitable for anticoagulation.
  • Anticoagulation is also recommended for elective cardioversion and AF with hyperthyroidism.

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