HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Rockson, S. G. Articles by Albers, G. W. Search for Related Content PubMed PubMed Citation Articles by Rockson, S. G. Articles by Albers, G. W.

STATE-OF-THE-ART PAPER

Comparing the guidelines: anticoagulation therapy to optimize stroke prevention in patients with atrial fibrillation

^* Stanford University, Stanford, California, USA

Manuscript received June 24, 2003; revised manuscript received October 31, 2003, accepted November 13, 2003.

^* Reprint requests and correspondence: Dr. Stanley G. Rockson, Division of Cardiovascular Medicine, Falk Cardiovascular Research Center, Stanford University, 300 Pasteur Drive, Stanford, California 94305, USA.
srockson{at}cvmed.stanford.edu

Atrial fibrillation (AF) is an important risk factor for stroke. According to a pooled analysis of controlled clinical trials with warfarin, anticoagulation therapy reduces stroke risk by 62%. However, clinicians must decide whether the benefit of long-term anticoagulation therapy with available agents outweighs the risk of bleeding for individual patients. Guidelines issued by the American College of Chest Physicians and by the joint American College of Cardiology, American Heart Association, and the European Society of Cardiology task force recommend antithrombotic therapy to protect AF patients from stroke based on risk-stratification algorithms. Risk factors for stroke AF patients include age 75 years; hypertension; thyrotoxicosis; diabetes; cardiovascular disease; congestive heart failure; and history of stroke, transient ischemic attack, or thromboembolism. Patients at high risk for stroke experience greater absolute benefit from anticoagulation therapy than patients at low risk. The guidelines are consistent in recommendations for high-risk patients (warfarin therapy, international normalized ratio 2.0 to 3.0) and low-risk patients (aspirin 325 mg), but differ for intermediate-risk patients with diabetes or heart disease. The guidelines continue to evolve, and future guidelines are likely to incorporate new clinical data, including the CHADS₂ algorithm for determining risk and the results of the Atrial Fibrillation Follow-up Investigation of Rhythm Management trial, the Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation study, and the Stroke Prevention Using an Oral Thrombin Inhibitor in Atrial Fibrillation II to V trials.

Abbreviations and Acronyms   ACC/AHA/ESC = American College of Cardiology/American Heart Association/European Society of Cardiology   ACCP = American College of Chest Physicians   AF = atrial fibrillation   AFFIRM = Atrial Fibrillation Follow-up Investigation of Rhythm Management trial   AFI = Atrial Fibrillation Investigators   CI = confidence interval   ICH = intracerebral hemorrhage   INR = international normalized ratio   RACE = Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation study   SBP = systolic blood pressure   SPAF = Stroke Prevention in Atrial Fibrillation   SPORTIF = Stroke Prevention Using an Oral Thrombin Inhibitor in Atrial Fibrillation trial   TIA = transient ischemic attack   vWf = von Willebrand factor

This article has been cited by other articles:

				C. L Garwood and T. L Corbett Use of Anticoagulation in Elderly Patients with Atrial Fibrillation Who Are at Risk for Falls Ann. Pharmacother., April 1, 2008; 42(4): 523 - 532. [Abstract] [Full Text] [PDF]

				J. Eldstrom, Z. Wang, H. Xu, M. Pourrier, A. Ezrin, K. Gibson, and D. Fedida The Molecular Basis of High-Affinity Binding of the Antiarrhythmic Compound Vernakalant (RSD1235) to Kv1.5 Channels Mol. Pharmacol., December 1, 2007; 72(6): 1522 - 1534. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. V. d. Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: full text: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) Eur. Heart J. Suppl., June 1, 2007; 9(suppl_C): C3 - C74. [Full Text] [PDF]

				Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. Van den Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) Eur. Heart J., January 1, 2007; 28(1): 88 - 136. [Full Text] [PDF]

				L Kalra, G Y H Lip, and on behalf of the Guideline Development Group for t Antithrombotic treatment in atrial fibrillation Heart, January 1, 2007; 93(1): 39 - 44. [Full Text] [PDF]

				A. Kollar, S. D. Lick, K. N. Vasquez, and V. R. Conti Relationship of Atrial Fibrillation and Stroke After Coronary Artery Bypass Graft Surgery: When is Anticoagulation Indicated? Ann. Thorac. Surg., August 1, 2006; 82(2): 515 - 523. [Abstract] [Full Text] [PDF]

				J. E. Saffitz Connexins, conduction, and atrial fibrillation. N. Engl. J. Med., June 22, 2006; 354(25): 2712 - 2714. [Full Text] [PDF]

				J. Emmerich, J.-Y. Le Heuzey, P. M.W. Bath, and S. J. Connolly Indication for antithrombotic therapy for atrial fibrillation: reconciling the guidelines with clinical practice Eur. Heart J. Suppl., May 1, 2005; 7(suppl_C): C28 - C33. [Abstract] [Full Text] [PDF]

				G. C. Gronefeld, S. H. Hohnloser, S. H. Konety, B. Olshansky, A. K. Wittkowsky, P. Alboni, G. I. Botto, and N. Baldi The "Pill-in-the-Pocket" Approach to Atrial Fibrillation N. Engl. J. Med., March 17, 2005; 352(11): 1150 - 1151. [Full Text] [PDF]

				S. J. Hazel, H. S. Paterson, J. R.M. Edwards, and G. J. Maddern Surgical Treatment of Atrial Fibrillation via Energy Ablation Circulation, March 1, 2005; 111(8): e103 - e106. [Full Text] [PDF]

				J. L. Halperin Ximelagatran: Oral direct thrombin inhibition as anticoagulant therapy in atrial fibrillation J. Am. Coll. Cardiol., January 4, 2005; 45(1): 1 - 9. [Abstract] [Full Text] [PDF]

				R. L. Page Newly Diagnosed Atrial Fibrillation N. Engl. J. Med., December 2, 2004; 351(23): 2408 - 2416. [Full Text] [PDF]