Anticoagulation therapy and the risk of stroke in patients with atrial fibrillation at ‘moderate risk’ [CHADS2 score=1]: Simplifying stroke risk assessment and thromboprophylaxis in real-life clinical practice

Gregory Y. H. Lip

doi:10.1160/TH10-01-0038

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2010; 103(04): 683-685
DOI: 10.1160/TH10-01-0038

Editorial Focus

Schattauer GmbH

Anticoagulation therapy and the risk of stroke in patients with atrial fibrillation at ‘moderate risk’ [CHADS₂ score=1]: Simplifying stroke risk assessment and thromboprophylaxis in real-life clinical practice

Authors

Gregory Y. H. Lip

¹University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham B18 7QH, United Kingdom

Abstract

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References

References
1 Hughes M, Lip GY. Guideline Development Group.. National Clinical Guideline for Management of Atrial Fibrillation in Primary and Secondary Care, National Institute for Health and Clinical Excellence. Stroke and thromboembolism in atrial fibrillation: a systematic review of stroke risk factors, risk stratification schema and cost effectiveness data. Thromb Haemost 2008; 99: 295-304.
2 McBane RD, Hodge DO, Wysokinski WE. Clinical and echocardiographic measures governing thromboembolism destination in atrial fibrillation. Thromb Haemost 2008; 99: 951-955.
3 Lip GY, Lim HS. Atrial fibrillation and stroke prevention. Lancet Neurol 2007; 06: 981-993.
4 Connolly SJ, Eikelboom J, O’Donnell M. et al. Challenges of establishing new antithrombotic therapies in atrial fibrillation. Circulation 2007; 116: 449-455.
5 Fang MC, Go AS, Chang Y. et al. Comparison of risk stratification schemes to predict thromboembolism in people with nonvalvular atrial fibrillation. J Am Coll Cardiol 2008; 51: 810-815.
6 Poli D, Antonucci E, Grifoni E. et al. Stroke risk in atrial fibrillation patients on warfarin. Predictive ability of risk stratification schemes for primary and secondary prevention. Thromb Haemost 2009; 101: 367-372.
7 Lip GY, Zarifis J, Watson RD. et al. Physician variation in the management of patients with atrial fibrillation. Heart 1996; 75: 200-205.
8 Nieuwlaat R, Capucci A, Lip GY. et al. Antithrombotic treatment in real-life atrial fibrillation patients: a report from the Euro Heart Survey on Atrial Fibrillation. Eur Heart J 2006; 27: 3018-3026.
9 Wysokinski WE, Owen WG, Fass DN. et al. 2nd. Atrial fibrillation and thrombosis: immunohisto-chemical differences between in situ and embolized thrombi. J Thromb Haemost 2004; 02: 1637-1644.
10 Kamath S, Blann AD, Chin BS. et al. A prospective randomized trial of aspirin-clopidogrel combination therapy and dose-adjusted warfarin on indices of thrombogenesis and platelet activation in atrial fibrillation. J Am Coll Cardiol 2002; 40: 484-490.
11 Mant J, Hobbs FD, Fletcher K. et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged study, BAFTA): a randomized controlled trial. Lancet 2007; 370: 493-503.
12 Rash A, Downes T, Portner R. et al. A randomised controlled trial of warfarin versus aspirin for stroke prevention in octogenarians with atrial fibrillation (WASPO). Age Ageing 2007; 36: 151-156.
13 Sato H, Ishikawa K, Kitabatake A. et al. Low-dose aspirin for prevention of stroke in low-risk patients with atrial fibrillation: Japan Atrial Fibrillation Stroke Trial. Stroke 2006; 37: 447-451.
14 Healey JS, Hart RG, Pogue J. et al. Risks and benefits of oral anticoagulation compared with clopidogrel plus aspirin in patients with atrial fibrillation according to stroke risk: The Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events (ACTIVE-W). Stroke 2008; 39: 1482-1486.
15 Lee BH, Park JS, Park JH. et al. The effect and safety of the anti-thrombotic therapies in patients with atrial fibrillation and CHADS2 score 1. J Cardiovasc Electrophysiol. 2010 in press.
16 Connolly SJ, Ezekowitz MD, Yusuf S. et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361: 1139-1151.
17 Gorin L, Fauchier L. Nonin. et al. Antithrombotic treatment and the risk of death and stroke in patients with atrial fibrillation and a CHADS2 score=1. Thromb Haemost 2010; 103: 833-840.
18 Singer DE, Albers GW, Dalen JE. et al. Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: 546S-592S.
19 Apostolakis S, Shantsila E, Lip GY. et al. Contra: “Anti-platelet therapy is an alternative to oral anticoagulation for atrial fibrillation“. Thromb Haemost 2009; 102: 914-915.
20 Healey JS. Pro: “Anti-platelet therapy is an alternative to oral anticoagulation for atrial fibrillation“. Thromb Haemost 2009; 102: 912-913.
21 Lip GYH, Nieuwlaat R, Pisters R. et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach. Chest. 2009 pre-published online doi:10.1378/chest.09-1584.
22 Lip GYH, Halperin JL. Improving stroke risk stratification in atrial fibrillation. Am J Med. 2010 in press.
23 Rietbrock S, Plumb JM, Gallagher AM. et al. How effective are dose-adjusted warfarin and aspirin for the prevention of stroke in patients with chronic atrial fibrillation? An analysis of the UK General Practice Research Database. Thromb Haemost 2009; 101: 527-534.
24 Tay KH, Lip GY, Lane DA. Atrial fibrillation and stroke risk prevention in real-life clinical practice. Thromb Haemost 2009; 101: 415-416.