Skip to main content

Antiplatelet Agents for Prevention of Thromboembolism in Atrial Fibrillation: When, Why, and Which One?

  • Conference paper
Cardiac Arrhythmias 2001

Zusammenfassung

Atrial fibrillation (AF) carries a high risk of systemic embolism, in particular stroke. This is true not only when AF is associated with valvular heart disease, but also in patients with nonvalvular AF, which represents 70% of all cases of AF [1]. However, the risk of stroke is not uniform, widely ranging between 0.4% and 12% per year, with an average of 4.5% per year observed in the pooled analysis of five randomized controlled trials [2].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Hart RG, Halperin JL (2001) Atrial fibrillation and stroke. Concepts and controversies. Stroke 32:803–808

    Article  CAS  PubMed  Google Scholar 

  2. Atrial Fibrillation Investigators (1994) Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials. Arch Intern Med 154:1449–1457

    Article  Google Scholar 

  3. Stein B, Fuster V, Halperin JL, Chesebro JH (1989) Antithrombotic therapy in cardiac disease. An emerging approach based on pathogenesis and risk. Circulation 80:1501–1513

    Article  CAS  PubMed  Google Scholar 

  4. Chesebro JH, Fuster V, Halperin JL (1991) Atrial fibrillation: risk marker for stroke. N Engl J Med 323:1556–1558

    Article  Google Scholar 

  5. Hart RG, Benavente O, McBride R, Pearce LA (1999) Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Ann Intern Med 131:492–501

    Article  CAS  PubMed  Google Scholar 

  6. Petersen P, Boysen G, Godtfredsen J et al (1989) Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK Study. Lancet 1:175–179

    Article  CAS  PubMed  Google Scholar 

  7. The Stroke Prevention in Atrial Fibrillation Investigators (1991) The Stroke Prevention in Atrial Fibrillation trial: final results. Circulation 84:527–539

    Article  Google Scholar 

  8. The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators (1990) The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. N Engl J Med 325:1505–1511

    Google Scholar 

  9. Connolly SJ, Laupacis A, Gent M et al for the CAFA study coinvestigators (1991) Canadian Atrial Fibrillation Anticoagulation (CAFA) study. J Am Coll Cardiol 18:349–355

    Article  CAS  PubMed  Google Scholar 

  10. Ezekowitz MD, Bridgers SL, James KE et al for the Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators (1992) Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. N Engl J Med 327:1406–1412

    Article  CAS  PubMed  Google Scholar 

  11. European Atrial Fibrillation Trial (EAFT) Study Group (1993) Secondary prevention in nonrheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 342:1255–1262

    Google Scholar 

  12. Stroke Prevention in Atrial Fibrillation Investigators (1994) Warfarin versus aspirin for prevention of thromboembolism in atrial fibrilllation: Stroke Prevention in Atrial Fibrillation II Study. Lancet 346:687–691

    Google Scholar 

  13. Stafford RS, Singer DE (1996) National patterns of warfarin use in atrial fibrillation. Arch Intern Med 156:2537–2541

    Article  CAS  PubMed  Google Scholar 

  14. Bungard TJ, Ghali WA, Teo KK et al (2000) Why do patients with atrial fibrillation not receive warfarin? Arch Intern Med 160:41–46

    Article  CAS  PubMed  Google Scholar 

  15. Cohen N, Sarafian DA, Alon I et al (2000) Warfarin for stroke prevention still underused in atrial fibrillation. Stroke 31:1217–1222

    Article  CAS  PubMed  Google Scholar 

  16. Stroke Prevention in Atrial Fibrillation Investigators (1996) Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high risk patients with atrial fibrillation: Stroke Prevention in Atrial Fibrillation III randomised clinical trial. Lancet 348:633–638

    Article  Google Scholar 

  17. Pengo V, Zasso A, Barbero F et al (1998) Effectiveness of fixed minidose warfarin in the prevention of thromboembolism and vascular death in nonrheumatic atrial fibrillation. Am J Cardiol 82:433–437

    Article  CAS  PubMed  Google Scholar 

  18. Gullov AL, Koefoed BG, Petersen P et al (1998) Fixed minidose warfarin and aspirin alone and in combination vs adjusted-dose warfarin for stroke prevention in atrial fibrillation. Arch Intern Med 158:1513–1521

    Article  CAS  PubMed  Google Scholar 

  19. Hellemons BS, Langenberg M, Lodder J et al (1999) Primary prevention of arterial thromboembolism in nonrheumatic atrial fibrillation in primary care: randomised control trial comparing two intensities of coumarin with aspirin. Br Med J 319:958–964

    Article  CAS  Google Scholar 

  20. Diener HC, Lowenthal A (1997) Antiplatelet therapy to prevent stroke: risk of brain hemorrhage and efficacy in atrial fibrillation. J Neurol Sci 153:112

    Article  Google Scholar 

  21. Posada IS, Barriales V for the LASAF pilot Study Group (1999) Alternate-day dosing of aspirin in atrial fibrillation. Am Heart J 138:137–143

    Article  Google Scholar 

  22. Benavente O, Hart RG, Koudstal P et al (1999) Antiplatelet therapy for preventing stroke in patients with nonvalvular atrial fibrillation and no previous history of stroke or transient ischemic attacks. In: Warlow C, Van Gijn J, Sandercock P (eds) Stroke module of the Cochrane database of systematic reviews. BMJ Publishing Group, London

    Google Scholar 

  23. Miller VT, Rothrock JF, Feinberg WM et al, on behalf of the Stroke Prevention in Atrial Fibrillation Investigators (1993) Ischemic stroke in patients with atrial fibrillation: effect of aspirin according to stroke mechanism. Neurology 43:32–36

    Article  CAS  PubMed  Google Scholar 

  24. Morocutti C, Amabile G, Fattapposta F et al (1997) Indobufen versus warfarin in the secondary prevention of major vascular events in nonrheumatic atrial fibrillation. Stroke 28:1015–1022

    Article  CAS  PubMed  Google Scholar 

  25. Taylor FC, Cohen H, Ebrahim S (2001) Systematic review of long term anticoagulation or antiplatelet treatment in patients with nonrheumatic atrial fibrillation. Br Med J 322:321–326

    Article  CAS  Google Scholar 

  26. The Stroke Prevention in Atrial Fibrillation Investigators (1992) Predictors of thromboembolism in atrial fibrillation: I. Clinical features of patients at risk. Ann Intern Med 116:1–5

    Article  Google Scholar 

  27. Atrial Fibrillation Investigators (1998) Echocardiographic predictors of stroke in patients with atrial fibrillation. A prospective study of 1066 patients from 3 clinical trials. Arch Intern Med 158:1316–1320

    Article  Google Scholar 

  28. Hart RG, Pearce LA, Mc Bride R et al, on behalf of the Stroke Prevention in Atrial Fibrillation (SPAF) Investigators (1999) Factors associated with ischemic stroke during aspirin therapy in atrial fibrillation. Analysis of 2012 participants in the SPAF I-III clinical trials. Stroke 30:1223–1229

    Article  CAS  PubMed  Google Scholar 

  29. Kopecky SL, Gersh BJ, McGoon MD et al (1987) The natural history of lone atrial fibrillation: a population-based study over three decades. N Engl J Med 317:669–674

    Article  CAS  PubMed  Google Scholar 

  30. Albers GW, Dalen JE, Laupacis A et al (2001) Antithrombotic therapy in atrial fibrillation. Sixth ACCP Consensus Conference on Antithrombotic Therapy. Chest 119[Suppl]:194S-206S

    Article  Google Scholar 

  31. The SPAF III Writing Committee for the Stroke Prevention in Atrial Fibrillation Investigators (1998) Patients with nonvalvular atrial fibrillation at low risk of stroke during treatment with aspirin. JAMA 279:1273–1277

    Article  Google Scholar 

  32. Di Pasquale G, Urbinati S, Pinelli G (1995) New echocardiographic markers of embolic risk in atrial fibrillation. Cerebrovasc Dis 5:315–322

    Article  Google Scholar 

  33. Zabalgoitia M, Halperin JL, Pearce LA et al (1998) Transesophageal echocardiographic correlates of clinical risk of thromboembolism in nonvalvular atrial fibrillation. J Am Coll Cardiol 31:1622–1626

    Article  CAS  PubMed  Google Scholar 

  34. The Investigators of FASTER Study (1996) Fibrillazione Atriale Studio Transesofageo Emiliano-Romagnolo, Italy: Transesophageal echocardiographic correlates of prior thromboembolism in non-valvular atrial fibrillation: a multicentre study. Eur Heart J 17[Suppl]:442 (abstr)

    Google Scholar 

  35. Ansell JE, Hughes R (1996) Evolving models of warfarin management: anticoagulation clinics, patient self-monitoring, and patient self-management. Am Heart J 132:1095–1100

    Article  CAS  PubMed  Google Scholar 

  36. Chiquette E, Amato MG, Bussey HI (1998) Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs. Arch Intern Med 158:1641–1647

    Article  CAS  PubMed  Google Scholar 

  37. Levine MN, Raskob G, Landefeld S, Kearon C (2001) Hemorrhagic complications of anticoagulant treatment. Sixth ACCP Consensus Conference on Antithrombotic Therapy. Chest 119[Suppl]:108S–121S

    Article  Google Scholar 

  38. Landefeld CS, Goldman L (1989) Major bleeding in outpatients treated with warfarin. Incidence and prediction by factors known at the start of outpatient therapy. Am J Med 87:144–152

    Article  CAS  PubMed  Google Scholar 

  39. Fihn SD, Mc Donell M, Martin D et al (1993) Risk factors for complications of chronic anticoagulation: a multicenter study. Ann Intern Med 118:511–520

    Article  CAS  PubMed  Google Scholar 

  40. Hylek EM, Singer DE (1994) Risk factors for intracranial hemorrhage in outpatients taking warfarin. Ann Intern Med 120:897–902

    Article  CAS  PubMed  Google Scholar 

  41. Palareti G, Poggi M, Guazzaloca G et al (1997) Assessment of mental ability in elderly anticoagulated patients: its reduction is associated with a less satisfactory quality of treatment. Blood Coagul Fibrinolysis 8:411–417

    Article  CAS  PubMed  Google Scholar 

  42. Palareti G, Leali N, Coccheri S et al, on behalf of the Italian Study on Complications of Oral Anticoagulant Therapy (1996) Bleeding complications of oral anticoagulant treatment: an inception-cohort, prospective collaborative study (ISCOAT). Lancet 348:423–428

    Article  CAS  PubMed  Google Scholar 

  43. Palareti G, Hirsh J, Legnani C et al (2000) Oral anticoagulation treatment in the elderly: a nested prospective, case-control study. Arch Intern Med 160:470–478

    Article  CAS  PubMed  Google Scholar 

  44. Pengo V, Legnani C, Noventa F, Palareti G, on behalf of the ISCOAT Study Group (2001) Oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and risk of bleeding. Thromb Haemost 85:418–422

    Google Scholar 

  45. Hylek EM, Skates SJ, Sheehan MA, Singer DE (1996) An analysis of the lowest effective intensity of prophylactic anticoagulation for patients with nonrheumatic atrial fibrillation. N Engl J Med 335:540–546

    Article  CAS  PubMed  Google Scholar 

  46. The European Atrial Fibrillation Study Group (1995) Optimal oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and recent cerebral ischemia. N Engl J Med 333:5–10

    Article  Google Scholar 

  47. Protheroe J, Fahey T, Montgomery AA, Peters TJ (2000) The impact of patient’s preferences on the treatment of atrial fibrillation: observational study of patient based decision analysis. Br Med J 320:1380–1384

    Article  CAS  Google Scholar 

  48. Man-Son-Hing M, Laupacis A, O’Connor AM et al, for the Stroke Prevention in Atrial Fibrillation Investigators (1999) A patient decision aid regarding antithrombotic therapy for stroke prevention in atrial fibrillation. JAMA 282:737–743

    Article  CAS  PubMed  Google Scholar 

  49. Anonimous (2001) Presentation of the 50th Annual Scientific Session of the American College of Cardiology, Orlando, Florida

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2002 Springer-Verlag Italia

About this paper

Cite this paper

Di Pasquale, G. et al. (2002). Antiplatelet Agents for Prevention of Thromboembolism in Atrial Fibrillation: When, Why, and Which One?. In: Raviele, A. (eds) Cardiac Arrhythmias 2001. Springer, Milano. https://doi.org/10.1007/978-88-470-2103-7_66

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2103-7_66

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2165-5

  • Online ISBN: 978-88-470-2103-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics