Download PDF
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)

    Permissions and Reprints

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.

KEYWORDS

atrial fibrillation - warfarin - INR - stroke - bleeding

REFERENCES

  • 1 Bellet S. Clinical Disorders of the Heart Beat, 3rd ed.  Philadelphia: Lea & Febiger 1971
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 10 Atrial Fibrillation Study Group Investigators. Stroke prevention in atrial fibrillation study. Final results.  Circulation . 1991;  84 527-539
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 37 Ezekowitz M D, Levine J A. Preventing stroke in patients with atrial fibrillation.  JAMA . 1999;  281 1830-1835
    CrossrefPubMedGoogle Scholar
  • 38 Hart R G, Halperin J L. Atrial fibrillation and stroke. Concepts and controversies.  Stroke . 2001;  32 803-808
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar