Semin Vasc Med 2003; 03(3): 333-338
DOI: 10.1055/s-2003-44469
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Oral Anticoagulant Therapy in Patients with Atrial Fibrillation

Vittorio Pengo
  • Department of Clinical Cardiology, Thrombosis Centre, University of Padova, Italy
Further Information

Publication History

Publication Date:
21 November 2003 (online)

ABSTRACT

In the absence of contraindications, patients with atrial fibrillation and at least one major risk factor for stroke should receive long-term oral anticoagulant treatment to prevent atrial thrombus formation. Because age of more than 75 years is a major risk factor for stroke, but is also a risk factor for major bleeding, the decision to treat elderly patients with anticoagulants should be made on an individual basis.

REFERENCES

  • 1 Bellet S. Clinical Disorders of the Heart Beat, 3rd ed.  Philadelphia: Lea & Febiger 1971
  • 2 Hart R G, Pearce L A, Rothbart R M, McAnulty J H, Asinger R W, Halperin J L. Stroke with intermittent atrial fibrillation: incidence and predictors during aspirin therapy. Stroke Prevention in Atrial Fibrillation Investigators.  Journal of the American College of Cardiology . 2000;  35 183-187
  • 3 Wolf P A, Abbott R D, Kannel W B. Atrial fibrillation as an independent factor for stroke: the Framingham study.  Stroke . 1991;  22 983-988
  • 4 Kannel W B, Abbott R D, Salvage D D. et al . Coronary heart disease and atrial fibrillation: the Framingham study.  Am Heart J . 1983;  106 389-396
  • 5 Kannel W B, Abbott R D, Salvage D D. et al . Epidemiologic features of chronic atrial fibrillation: the Framingham study.  N Engl J Med . 1982;  306 1018-1022
  • 6 Phillips S J, Whisnan J P, O'Fallon W M, Freye R L. Prevalence of cardiovascular diseases and diabetes mellitus in residents of Rochester, Minnesota.  Mayo Clin Proc . 1990;  65 344-359
  • 7 Wolf P A, Abbott R D, Kannel W B. Atrial fibrillation: a major contributor to stroke in the elderly.  Arch Intern Med . 1987;  147 1561-1564
  • 8 Ezekowitz M D, James K E, Nazarian S M. et al . Silent cerebral infarction in patients with nonrheumatic atrial fibrillation.  Circulation . 1995;  92 2178-2182
  • 9 Petersen P, Boysen G, Godtredsen, Andersen E D, Andersen B. Placebo-controlled, randomized trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation.  Lancet . 1989;  1 175-179
  • 10 Atrial Fibrillation Study Group Investigators. Stroke prevention in atrial fibrillation study. Final results.  Circulation . 1991;  84 527-539
  • 11 The Boston Area Anticoagulation Trial For Atrial Fibrillation Investigators. The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation.  N Engl J Med . 1990;  323 1505-1511
  • 12 Connolly S J, Laupacis A, Gent M, Roberts R S, Cairns J A, Joyner C. Canadian atrial fibrillation study.  J Am Coll Cardiol . 1991;  18 349-355
  • 13 Ezekowitz M D, Bridgers S L, James K E. et al . Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation.  N Engl J Med . 1992;  327 1406-1412
  • 14 Feinberg W M, Blackshear J L, Laupacis A, Kronmal R, Hart R G. Prevalence, age distribution, and gender of patients with atrial fibrillation.  Arch Intern Med . 1995;  155 469-473
  • 15 Stroke Prevention in Atrial Fibrillation Investigators. Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study.  Lancet . 1994;  343 687-691
  • 16 Bern M M, Lokich J J, Wallach S R. et al . Very low doses of warfarin can prevent thrombosis in central venous catheters. A randomized prospective trial.  Ann Intern Med . 1990;  112 423-428
  • 17 Levine M, Hirsh J, Gent M. et al . Double-blind randomized trial of very-low-dose warfarin for prevention of thromboembolism in stage IV breast cancer.  Lancet . 1994;  343 886-889
  • 18 Gullov A L, Keofoed B G, Petersen P. et al . Fixed mini-dose warfarin and aspirin alone and in combination versus adjusted-dose warfarin for the stroke prevention in atrial fibrillation; second Copenhagen Atrial Fibrillation, Aspirin and Anticoagulation study (the AFASAK2 study).  Arch Intern Med . 1998;  158 1513-1521
  • 19 Pengo V, Zasso A, Barbero F. et al . Effectiveness of fixed mini-dose warfarin in the prevention of thromboembolism and vascular death in nonrheumatic atrial fibrillation.  Am J Cardiol . 1998;  82 433-437
  • 20 Stroke Prevention in Atrial Fibrillation Investigators. Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high risk patients with atrial fibrillation: Stroke Prevention in Atrial Fibrillation III randomized clinical trial.  Lancet . 1996;  348 633-638
  • 21 Hylek E M, Skates S J, Sheehan M A, Singer D E. An analysis of the lowest effective intensity of prophylactic anticoagulation for patients with nonrheumatic atrial fibrillation.  N Engl J Med . 1996;  335 540-546
  • 22 Laupacis A, Albers G W, Dalen J E, Dunn M I, Jacobson A K, Singer D. Antithrombotic therapy in atrial fibrillation.  Chest . 1998;  114(suppl) 579S-589S
  • 23 Atrial Fibrillation Investigators. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials.  Arch Intern Med . 1994;  154 1449-1457
  • 24 SPAF III Writing Committee for the Stroke Prevention in Atrial Fibrillation Investigators. Patients with nonvalvular atrial fibrillation at low risk of stroke during treatment with aspirin: Stroke Prevention in Atrial Fibrillation III Study.  JAMA . 1998;  279 1273-1277
  • 25 Atrial Fibrillation Investigators. Echocardiographic predictors of stroke in patients with atrial fibrillation: a prospective study of 1.066 patients from 3 clinical trials.  Arch Intern Med . 1998;  158 1316-1320
  • 26 Pengo V, Filippi B, Biasiolo A, Pegoraro C, Noventa F, Iliceto S. Association of the G20210A mutation in the factor II gene with systemic embolism in nonvalvular atrial fibrillation.  Am J Cardiol . 2002;  90 545-547
  • 27 Albers G W, Dalen J E, Laupacis A, Manning W J, Petersen P, Singer D E. Antithrombotic therapy in atrial fibrillation.  Chest . 2001;  119 194S-206S
  • 28 Palareti G, Leali N, Coccheri S. et al . Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaboratory study (ISCOAT).  Lancet . 1996;  348 423-428
  • 29 Fihn S D, Callaghan C M, Martin D C. et al . The risk for and the severity of bleeding complications in elderly patients treated with warfarin.  Ann Intern Med . 1996;  124 970-979
  • 30 Pengo V, Legnani C, Noventa F, Palareti G. Oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and risk of bleeding: a multicenter inception cohort study.  Thromb Haemost . 2001;  85 418-422
  • 31 Cannegieter S C, Rosendaal F R, Wintzen A R. et al . Optimal oral anticoagulant therapy in patients with mechanical heart valves.  N Engl J Med . 1995;  333 11-17
  • 32 Landefeld C S, Goldman L. Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy.  Am J Med . 1989;  87 144-152
  • 33 Beyth B J, Quinn L M, Landefeld C S. Prospective evaluation of an index for predicting the risk of major bleeding in outpatients treated with warfarin.  Am J Med . 1998;  105 91-99
  • 34 Cortelazzo S, Finazzi G, Viero P, Galli M, Remuzzi A, Parenzan L, Barbui T. Thrombotic and hemorrhagic complications in patients with mechanical heart valve prosthesis attending an anticoagulation clinic.  Thromb Haemost . 1993;  69 316-320
  • 35 Pengo V, Peruzzi P, Marzari A, Zanon F, Banzato A, Schivazappa L. Advantages of a specific ambulatory for patients following oral anticoagulant therapy.  G Ital Cardiol . 1989;  19 1125-1128
  • 36 Palareti G, Poggi M, Guazzaloca G, Savino A, Coccheri S. Assessment of mental ability in elderly anticoagulated patients; its reduction is associated with a less satisfactory quality of treatment.  Blood Coagul Fibrinolys . 1997;  8 411-417
  • 37 Ezekowitz M D, Levine J A. Preventing stroke in patients with atrial fibrillation.  JAMA . 1999;  281 1830-1835
  • 38 Hart R G, Halperin J L. Atrial fibrillation and stroke. Concepts and controversies.  Stroke . 2001;  32 803-808
  • 39 Klein A L, Grimm R A, Murray D. et al . Use of transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation.  N Engl J Med . 2001;  344 1411-1420
  • 40 Sievert H, Lesh M D, Trepels T. et al . Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation.  Circulation . 2002;  105 1887-1889
  • 41 Albers G W, Yim J M, Belew K M. et al . Status of antithrombotic therapy in patients with atrial fibrillation in university hospitals.  Arch Intern Med . 1996;  156 2311-2316
  • 42 Munschauer F E, Priore R L, Hens M, Castilone A. Thromboembolism prophylaxis in chronic atrial fibrillation. Practice patterns in community and tertiary care hospitals.  Stroke . 1997;  28 72-76
  • 43 Gurevitz J H, Monette J, Ronchon P A, Eckler M A, Avorn J. Atrial fibrillation and stroke prevention with warfarin in the long-term care setting.  Arch Intern Med . 1987;  157 978-984
  • 44 White R H, McBurnie M A, Manolio T. et al . Oral anticoagulation in patients with atrial fibrillation: adherence with guidelines in an elderly cohort.  Am J Med . 1999;  106 165-171
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