Prevention of thromboembolism in atrial fibrillation

Abstract

OBJECTIVE: Appropriate use of drugs to prevent thromboembolism in patients with atrial fibrillation (AF) involves comparing the patient's risk of stroke and risk of hemorrhage. This review summarizes the evidence regarding the efficacy of these medications. METHODS:We conducted a meta-analysis of randomized controlled trials of drugs used to prevent thromboembolism in adults with nonpostoperative AF. Articles were identified through the Cochrane Collaboration's CENTRAL database and MEDLINE until May 1998. A trial fibrillation (AF) is an increasingly common cardiac dysrhythmia affecting over 2 million people in the United States. 1-3 Restoration of sinus rhythm may involve consultation with a cardiologist; however, the prevention of cardioembolic events in patients who remain in AF falls within the domain of the primary care physician. 4 With a recently estimated 3.9 million office visits yearly for patients with AF, 5 internists need to aware of the current evidence regarding prevention of thromboembolic disease in order to provide the best care for their patients. MAIN RESULTS:The estimate that only one third of patients in AF are receiving warfarin is remarkably consistent across studies, 4,6-8 and has raised concerns that warfarin is greatly underutilized in patients with chronic AF. However, for interventions like warfarin that involve significant trade-offs, clinicians need a reliable synthesis of information on risks and benefits in order to make appropriate recommendations to patients. Therefore, we reviewed all of the randomized controlled trials involving anticoagulants and antiplatelet agents in the prevention of thromboembolism in patients with AF. Our aim was to evaluate the strength of the evidence on the efficacy and safety of the drugs used for the prevention of thromboembolic complications in adults with nonpostoperative AF and to report this information in a format useful to clinicians.

Development of a decision aid for patients with atrial fibrillation who are considering antithrombotic therapy

“…We thought that the most reliable and accurate estimate of the efficacy of aspirin was provided by a pooled analysis of individual patients (relative risk reduction of 21%). 7 The decision aid was developed before the publication of two recent meta‐analyses 8,9 that have revised the estimates of the efficacy of aspirin and warfarin to prevent stroke in patients with atrial fibrillation.…”

“…Patients with atrial fibrillation are five times more likely to suffer a stroke compared with those without atrial fibrillation. 5 To prevent stroke from atrial fibrillation, both warfarin and aspirin have been extensively studied in randomized trials 6–9 and are commonly used in clinical practice. Warfarin is more efficacious but has a greater number of adverse effects and is more inconvenient to use.…”

Combined anticoagulation and antiplatelet therapy for high-risk patients with atrial fibrillation: a systematic review

“…Provided no additional data on included or identified no new primary studies (n = 18) 20,[74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90] Longitudinal data from RCTs evaluating other ACTs (n = 4)…”

Atrial fibrillation post cardiac bypass surgery

“…[78] Anticoagulation should be considered in patients 75 years or older and patients with risk factors for stroke, while antiplatelet agents may prove useful in younger patients, subgroups in whom anticoagulation is contraindicated, and in patients with low risk for stroke. [79]…”