Atrial fibrillation and stroke prevention

被引:181
作者
Lip, Gregory Y. H. [1 ]
Lim, Hoong Sem [1 ]
机构
[1] City Hosp, Univ Dept Med, GYH Lip, Birmingham B18 7QH, W Midlands, England
关键词
D O I
10.1016/S1474-4422(07)70264-8
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Atrial fibrillation (AF) is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Anticoagulant therapy reduces the risk of stroke, and the greatest benefit is seen in patients at highest absolute risk. Aspirin is a less effective alternative, and any benefit of aspirin might be due to its favourable effects on arterial thrombosis caused by vascular disease. However, anticoagulant therapy remains underused, particularly in the elderly, who probably have the most to gain from stroke prevention owing to their high absolute risk. The underuse of anticoagulation might also be related to uncertain risk of thromboembolism in individual patients and a perceived overestimation of the benefit and underestimation of risk of bleeding with warfarin in clinical trials. In this Review, we summarise the data for and against warfarin and aspirin therapies and discuss the clinical assessments and risk stratifications that guide the use of antithrombotic therapy for stroke prevention in patients with AF. Possible barriers to the uptake of anticoagulation therapy are also discussed.
引用
收藏
页码:981 / 993
页数:13
相关论文
共 110 条
[1]   Guidelines for the early management of adults with ischemic stroke - A guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the atherosclerotic peripheral vascular disease and quality of care outcomes in research interdisciplinary working groups [J].
Adams, Harold P., Jr. ;
del Zoppo, Gregory ;
Alberts, Mark J. ;
Bhatt, Deepak L. ;
Brass, Lawrence ;
Furlan, Anthony ;
Grubb, Robert L. ;
Higashida, Randall T. ;
Jauch, Edward C. ;
Kidwell, Chelsea ;
Lyden, Patrick D. ;
Morgenstern, Lewis B. ;
Qureshi, Adnan I. ;
Rosenwasser, Robert H. ;
Scott, Phillip A. ;
Wijdicks, Eelco F. M. .
STROKE, 2007, 38 (05) :1655-1711
[2]  
Baigent C, 2002, BMJ-BRIT MED J, V324, P71, DOI 10.1136/bmj.324.7329.71
[3]   Can patients at elevated risk of stroke treated with anticoagulants be further risk stratified? [J].
Baruch, Lawrence ;
Gage, Brian F. ;
Horrow, Jay ;
Juul-Moller, Steen ;
Labovitz, Arthur ;
Persson, Maria ;
Zabalgoitia, Miguel .
STROKE, 2007, 38 (09) :2459-2463
[4]  
Benavente O, 1999, STROKE MODULE COCHRA
[5]   Prospective evaluation of an index for predicting the risk of major bleeding in outpatients treated with warfarin [J].
Beyth, RJ ;
Quinn, LM ;
Landefeld, CS .
AMERICAN JOURNAL OF MEDICINE, 1998, 105 (02) :91-99
[6]   A multicomponent intervention to prevent major bleeding complications in older patients receiving warfarin - A randomized, controlled trial [J].
Beyth, RJ ;
Quinn, L ;
Landefeld, CS .
ANNALS OF INTERNAL MEDICINE, 2000, 133 (09) :687-695
[7]   Thoracoscopic extracardiac obliteration of the left atrial appendage for stroke risk reduction in atrial fibrillation [J].
Blackshear, JL ;
Johnson, WD ;
Odell, JA ;
Baker, VS ;
Howard, M ;
Pearce, L ;
Stone, C ;
Packer, DL ;
Schaff, HV .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 42 (07) :1249-1252
[8]  
Blackshear JL, 1996, LANCET, V348, P633
[9]   Ximelagatran: An eulogy [J].
Boos, Christopher J. ;
Lip, Gregory Y. H. .
THROMBOSIS RESEARCH, 2006, 118 (03) :301-304
[10]   Effects of a perindopril-based blood pressure-lowering regimen on the risk of recurrent stroke according to stroke subtype and medical history - The PROGRESS trial [J].
Chapman, N ;
Huxley, R ;
Anderson, C ;
Bousser, MG ;
Chalmers, J ;
Colman, S ;
Davis, S ;
Donnan, G ;
MacMahon, S ;
Neal, B ;
Warlow, C ;
Woodward, M .
STROKE, 2004, 35 (01) :116-121