A Clinical Prediction Rule to Identify Patients With Atrial Fibrillation and a Low Risk for Stroke While Taking Aspirin

Walraven, Carl van; Hart, Robert G.; Wells, George A.; Petersen, Palle; Koudstaal, Peter J.; Gulløv, Annette Lemche; Hellemons, B S P; Koefed, Birgitte G.; Laupacis, Andreas

doi:10.1001/archinte.163.8.936

Cited by 181 publications

(74 citation statements)

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“…11 -13 Van Walraven et al also analyzed data from 6 small clinical trials and found that myocardial infarction was significantly associated with stroke. 12 In AF patients, the observed rate of stroke was 5.6 per 100 person-years in patients with a history of myocardial infarction or angina pectoris and only 1.4 in patients without a history of myocardial infarction or angina pectoris. 12 In alignment, Aronow et al found that a history of myocardial infarction was associated with an odds ratio of 4.8 for thromboembolic stroke.…”

Section: Vascular Disease and Stroke Risk In Atrial Fibrillationmentioning

confidence: 93%

“…12 In AF patients, the observed rate of stroke was 5.6 per 100 person-years in patients with a history of myocardial infarction or angina pectoris and only 1.4 in patients without a history of myocardial infarction or angina pectoris. 12 In alignment, Aronow et al found that a history of myocardial infarction was associated with an odds ratio of 4.8 for thromboembolic stroke. 13 The NICE (National Institute for Health and Clinical Excellence) guidelines systematic review did conclude that prior myocardial infarction was a stroke risk factor in AF.…”

Section: Vascular Disease and Stroke Risk In Atrial Fibrillationmentioning

confidence: 93%

“…34 Van Walravan et al found that in AF patients included in 6 small clinical trials, 19.7% had a history of myocardial infarction or angina pectoris. 12 …”

Section: Vascular Disease In Atrial Fibrillationmentioning

confidence: 99%

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Atrial Fibrillation and Vascular Disease—A Bad Combination

Olesen

Gislason

Torp‐Pedersen

et al. 2012

Clinical Cardiology

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This article provides an overview of (i) the risk of stroke associated with vascular disease (acute coronary syndromes and peripheral artery disease) in patients with atrial fibrillation, (ii) the frequent coexistence of vascular disease in patients with atrial fibrillation and, (iii) the cardiovascular risk associated with the coexisting of the two diseases. The literature on this topic is relatively sparse, and we discuss results from both clinical trials and observational studies.There is a clear indication of an increased stroke risk associated with vascular disease in patients with atrial fibrillation. Indeed, patients with atrial fibrillation often had coexisting vascular disease (around 18%), and the combination of the two diseases substantially increases the risk of future cardiovascular events. The increased risk associated with peripheral artery disease in atrial fibrillation is even more pronounced.Patients with atrial fibrillation and stable vascular disease should be treated with oral anticoagulation only, although when these patients present with acute coronary syndrome and/or undergo coronary stenting, concomitant treatment with antiplatelet drugs is indicated. To guide antithrombotic management in patients with atrial fibrillation, several stroke and bleeding risk prediction schemes have been developed. Clin. Cardiol. 2012 DOI: 10.1002/clc.20955Dr. Olesen received an honorarium through an educational grant from Sanofi Aventis for time and expertise spent writing this article. Dr Lip has served as a consultant for Bayer, Astellas, Merck, AstraZeneca, Sanofi, BMS/Pfizer, Biotronik, Portola and Boehringer Ingelheim and has been on the speakers bureau for Bayer, BMS/Pfizer, Boehringer Ingelheim, and Sanofi‐Aventis. Drs. Gislason and Torp‐Pedersen disclose no conflicts of interest.

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Section: Vascular Disease and Stroke Risk In Atrial Fibrillationmentioning

confidence: 93%

Section: Vascular Disease and Stroke Risk In Atrial Fibrillationmentioning

confidence: 93%

See 1 more Smart Citation

Atrial Fibrillation and Vascular Disease—A Bad Combination

Olesen

Gislason

Torp‐Pedersen

et al. 2012

Clinical Cardiology

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“…Kliniczne skale ryzyka udaru mózgu i zatorowości w krążeniu systemowym Proste, dające się wykorzystywać w praktyce klinicznej schematy stratyfikacji ryzyka udaru mózgu u pacjentów z AF opracowano pod koniec lat 90. XX wieku w małych badaniach kohortowych, a później udoskonalono je i poddano walidacji w większych populacjach [364][365][366][367][368]. Wprowadzenie skali CHA 2 DS 2 -VASc (tab.…”

Section: Przewidywanie Ryzyka Udaru Mózguunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,385

4,206

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“…This patient had a relative high risk of recurrent stroke because her CHADS2 index was 4 with age 75 years or older, prior stroke history, heart failure [8]. The stroke rate per 100 patient-years is 8.5 (95% CI, 6.3-11.1) for a score of 4 [9].…”

Section: Discussionmentioning

confidence: 98%

Acute Mesenteric Ischemia after Recurrent Embolic Stroke

Oguro¹,

Yamaguchi²

2015

Int J Gastroenterol Disord Ther

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We report the case of a 76-year-old woman with acute mesenteric artery ischemia and atrial fibrillation after recurrent embolic strokes. She had sudden severe abdominal pain and vomiting, and was admitted to the hospital in coma and shock state. Accompanied with metabolic acidosis and multiple organic failures, she died at 13 hours after the onset. Pathological examination revealed that acute thrombotic occlusion of superior mesenteric artery, splenic artery and right celiac artery. The occluded arteries pathologically showed progressive arteriosclerotic change and secondary multiple thrombi. This case demonstrated that atrial fibrillation with recurrent embolic stroke could cause mesenteric artery ischemia, progressive thrombi of abdominal viscera and sudden death. Acute Mesenteric Ischemia after Recurrent Embolic Stroke Keywords:Acute mesenteric ischemia, Recurrent embolic stroke, Case ReportOpen Access IntroductionAcute mesenteric artery ischemia is relatively rare acute abdominal vascular event caused by aging, atrial fibrillation, aortic atheroma and infectious endocarditis [1, 2]. The incidence is 5.3 per 100,000 inhabitants yearly, and its mortality is 60% to 80% [3]. It counts 0.4 % in patients with acute abdominal pain. Acute mesenteric ischemia is a life-threatening emergency that requires early diagnosis, intervention to restore mesenteric blood flow and resection of the necrotic bowel tissues by surgical treatments [4]. This report describes a patient with atrial fibrillation and recurrent stroke which rarely cause acute mesenteric ischemia and sudden death with multiple organic failures and lower limb ischemia. After stroke onset sudden abdominal pain and followed by shock state is suggestive of diagnosis of acute mesenteric ischemia. Case ReportA 77-year-old Japanese woman with atrial fibrillation and hypercardiomyopathy was treated by a cardiologist. Two months earlier she had embolic strokes of the right middle cerebral artery, then oral anticoagulation by warfarin had been administered to prevent recurrent stroke. In spite of controlling anticoagulant therapy by warfarin within two months, the prothrombin time-international normalized ratio(PT-INR) with 10 times analysis, three of ten times apparently showed inadequate values below the therapeutic range (0.93, 1.00 and 1.33). The CT scan of the head showed hemorrhagic infarction caused by recanalization after occlusion of the right middle cerebral artery (Figure 1). The echocardiography showed left atrial spontaneous echo contrast on previous stroke onset. On the 66 th day after the stroke onset, she experienced severe nausea, vomiting and abdominal pain in the morning, and delivered to our hospital. On arrival at our emergency department, she was coma. Her blood pressure could not be measured, and heart rater pulse was 124 bpm with irregular rhythm. Respiratory rate was 42/min and her temperature was 34.2 degrees. Right lower limb showed pale color and hemorrhagic purpura with pulseless iliac artery. Her abdomen showed rebound tenderne...

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A Clinical Prediction Rule to Identify Patients With Atrial Fibrillation and a Low Risk for Stroke While Taking Aspirin

Abstract: Irrespective of age, patients with AF and none of these 4 clinical features and who take aspirin have stroke rates comparable to those of age-matched community cohorts and would not benefit substantially from anticoagulation.

Cited by 181 publications

References 43 publications

Atrial Fibrillation and Vascular Disease—A Bad Combination

Atrial Fibrillation and Vascular Disease—A Bad Combination

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Acute Mesenteric Ischemia after Recurrent Embolic Stroke

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