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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Indication for antithrombotic therapy for atrial fibrillation: reconciling the guidelines with clinical practice

Joseph Emmerich1,*, Jean-Yves Le Heuzey2, Philip M.W. Bath3 and Stuart J. Connolly4

1Department of Vascular Medicine and Hypertension and INSERM U428, Hôpital Européen Georges Pompidou, Médecine Vasculaire—HTA, University Paris V, 20 rue Leblanc, 75908 Paris Cedex 15, France
2Department of Cardiology, Hôpital Européen Georges Pompidou, University Paris V, Paris, France
3Institute of Neuroscience, University of Nottingham, Nottingham, UK
4Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

* Corresponding author. Tel: +33 1 5609 3051; fax: +33 1 5609 3065. E-mail address: joseph.emmerich{at}egp.aphp.fr

Cardioembolic stroke secondary to atrial fibrillation (AF) is an urgent public-health problem. On the basis of the data from several randomized controlled clinical trials and pooled analyses, several guidelines have been published to promote the use of anticoagulant treatment to prevent stroke in patients with AF. Current evidence-based guidelines recommend long-term anticoagulation for most patients with AF. However, only a small proportion of patients with AF whom best-practice guidelines identify as eligible for oral anticoagulant therapy actually receive it. One explanation for this low implementation is attributed to the high selection criteria of patients in randomized clinical studies, which often included patients with a lower risk of bleeding than those treated in clinical practice. Indeed, the fear of bleeding is a major consideration when implementing anticoagulation therapy as the risk of bleeding may be higher than the risk of stroke for some patients, which may explain why some physicians do not perceive the guidelines to be fully justified in clinical practice. Considering the complexities surrounding prescribing oral anticoagulation in patients with AF, new drugs with a better benefit/risk ratio are therefore required in the armamentarium for the prevention of thromboembolic events in patients with AF.

Key Words: Atrial fibrillation • Coagulation • Stroke • Treatment guidelines • Vitamin K antagonists • Warfarin


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