Skip Navigation

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Villani, G.Q.
Right arrow Articles by Capucci, A.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Villani, G.Q.
Right arrow Articles by Capucci, A.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?


Anticoagulation in atrial fibrillation: what is certain and what is to come

G.Q. Villani*, M. Piepoli, P.E. Villani and A. Capucci

Divisione di Cardiologia, Ospedale Civile, Piacenza, Italy

* Dr Giovanni Quinto Villani, Divisione di Cardiologia, Ospedale Civile, Via Taverna 49, 29100 Piacenza, Italy

Abstract

Thromboembolism is the major complication in atrial fibrillation, prevention of which constitutes a major challenge in the modern treatment of this common arrhythmia. Treatment with oral anticoagulation is considered the ‘gold standard’, although several controversial issues have been raised concerning its use in all subgroups of patients affected by atrial fibrillation. In this review, the ‘state of the art’ treatment strategies in this important and potentially lethal clinical complication are discussed, with particular attention given to issues that remain unresolved. Finally, current proven and accepted therapeutic approaches are presented.

Key Words: Atrial fibrillation • Anticoagulant therapy

References

  1. Feinberg WM, Blackshear JL, Laupacis A, et al. Prevalence, age distribution and gender of patients with atrial fibrillation. Analysis and implications. Arch Intern Med. 1995;155:469–473[Abstract/Free Full Text]
  2. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham study. Stroke. 1991;22:983–988[Abstract/Free Full Text]
  3. Petersen P, Boysen G, Godtfredsen J, et al. Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study. Lancet. 1989;1:175–179[Web of Science][Medline]
  4. 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[Abstract]
  5. Stroke Prevention in Atrial Fibrillation Study. Final results. Circulation. 1991;84:527–539[Abstract/Free Full Text]
  6. Connolly SJ, Laupacis A, Gent M, et al. Canadian Atrial Fibrillation Anticoagulation (CAFA) Study. J Am Coll Cardiol. 1991;18:349–355[Abstract]
  7. Ezekowitz MD, Bridgers SL, James KE, et al. Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators. N Engl J Med. 1992;327:1406–1412[Abstract]
  8. EAFT (European Atrial Fibrillation Trial) Study Group. Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet. 1993;342:1255–1262[Web of Science][Medline]
  9. Hart RG, Benavente D, McBride R, et al. Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: a meta-analysis. Ann Intern Med. 1999;131:492–501[Abstract/Free Full Text]
  10. Petersen P, Boyson G, Godtfredsen J, et al. Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study. Lancet. 1989;1:175–179
  11. Gullov AL, Koefoed BG, Petersen P, et al. Fixed minidose warfarin and aspirin alone and in combination vs adjusted-dose warfarin for stroke prevention in atrial fibrillation: Second Copenhagen Atrial Fibrillation, Aspirin, and Anticoagulation Study. Arch Intern Med. 1998;158:1513–1521[Abstract/Free Full Text]
  12. Posada IS, Barriales V. Alternate-day dosing of aspirin in atrial fibrillation. LASAF Pilot Study Group. Am Heart J. 1999;138:137–143[CrossRef][Web of Science][Medline]
  13. Diener HC, Lowenthal A. Antiplatelet therapy to prevent stroke: risk of brain hemorrage and efficacy in atrial fibrillation. J Neurol Sci. 1997;153:112[CrossRef][Web of Science]
  14. Hellemons BS, Langerberg M, Lodder J, et al. Primary prevention of arterial thromboembolism in patients with non-rheumatic atrial fibrillation in general practice (the PATAF study). [abstract]Cerebrovasc Dis. 1997;7(Suppl 4):11
  15. Benavente O, Hart R, Koudstaal P, et al. Antiplatelet therapy for preventing stroke in patients with nonvalvular atrial fibrillation and no previous history of stroke or transient ischemic attack. Warlow C, Van Gijn J, Sandercock P. Stroke module of Cochrane database of systematic reviews. Oxford: The Cochrane Collaboration; 1999. p. 121–128
  16. Hart RG, Pearce LA, Miller VT, et al. Cardioembolic vs. non-cardioembolic strokes in atrial fibrillation: frequency and effect of antithrombotic agents in the stroke prevention in atrial fibrillation studies. Cerebrovasc Dis. 2000;10:39–43[CrossRef][Web of Science][Medline]
  17. Laupacis A, Albers G, Dalen J, et al. Antithrombotic therapy in atrial fibrillation. Chest. 1998;114(5):579S–589S Suppl[Free Full Text]
  18. The European Atrial Fibrillation Trial Study Group. Optimal oral anticoagulant therapy in patients with nonrheumatic atrial fibrillation and recent cerebral ischemia. N Engl J Med. 1995;333:5–10[Abstract/Free Full Text]
  19. Stroke prevention in Atrial Fibrillation Investigators. Predictors of thromboembolism in atrial fibrillation: I. Clinical features of patients at risk. Ann Intern Med. 1992;116:1–5
  20. Stroke Prevention in Atrial Fibrillation Investigators. Predictors of thromboembolism in atrial fibrillation: II. Echocardiographic features of patients at risk. Ann Intern Med. 1992;116:6–12
  21. Hart RG, Pearce LA, McBride R, et al. Factors associated with ischemic stroke during aspirin therapy of atrial fibrillation: analysis of 2012 participants in the SPAF I–III clinical Atrial Fibrillation (SPAF) Investigators. Stroke. 1999;30:1223–1229[Abstract/Free Full Text]
  22. Goldstein LB, Adams R, Becker K, et al. Primary prevention of ischemic stroke: a statement for healthcare professionals from the Stroke Council of the American Heart Association. Circulation. 2001;103:163–182[Free Full Text]
  23. Levy S, Breithardt G, Campbell RW, et al. Atrial fibrillation: current knowledge and recommendations for management. Working Group on Arrhythmias of the European Society of Cardiology. Eur Heart J. 1998;19:1294–1320[Abstract/Free Full Text]
  24. Buckingham TA, Hatala R. Anticoagulants for atrial fibrillation: why is the treatment rate so low? Clin Cardiol. 2002;25:447–454[Web of Science][Medline]
  25. Ibrahim SA, Kwoh CK. Underutilization of oral anticoagulant therapy for stroke prevention in elderly patients with heart failure. Am Heart J. 2000;140:219–220[CrossRef][Web of Science][Medline]
  26. Brass LM, Krumholz HM, Scinto JM, et al. Warfarin use among patients with atrial fibrillation. Stroke. 1997;28:2382–2389[Abstract/Free Full Text]
  27. Bungard TJ, Ackman ML, Ho G, et al. Adequacy of anticoagulation in patients with atrial fibrillation coming to a hospital. Pharmacotherapy. 2000;20:1060–1065[CrossRef][Web of Science][Medline]
  28. Levine MN, Raskob G, Landefeld S, et al. Hemorrhagic complications of anticoagulant treatment. Chest. 2001;119(1):108S–121S Suppl[Free Full Text]
  29. Sebastian JL, Tresch DD. Use of oral anticoagulants in older patients. Drugs Aging. 2000;16:409–435[CrossRef][Web of Science][Medline]
  30. Laupacis A, Albers G, Dale J, et al. Antithrombotic therapy in atrial fibrillation. Chest. 1995;108(4):352S–359S Suppl[Free Full Text]
  31. Taylor FC, Cohen H, Ebrahim S. Systematic review of long term anticoagulation or antiplatelet treatment in patients with non-rheumatic atrial fibrillation. BMJ. 2001;322:321–326[Abstract/Free Full Text]
  32. Gage BF, Cardinalli AB, Owens DK. Cost-effectiveness of preference-based antithrombotic therapy for patients nonvalvular atrial fibrillation. Stroke. 1998;29:1083–1091[Abstract/Free Full Text]
  33. Gustafsson C, Asplund K, Britton M, et al. Cost effectiveness of primary stroke prevention in atrial fibrillation: a Swedish national perspective. BMJ. 1992;305:1457–1460
  34. Protheroe J, Fahey T, Montgomery AA, et al. The impact of patient's preferences on the treatment of atrial fibrillation: an observational study of patient based decision analysis. BMJ. 2000;320:1380–1384[Abstract/Free Full Text]
  35. Matchan DB, McCrory DC, Barnett HJ, et al. Medical treatment for stroke prevention. Ann Intern Med. 1994;121:41–53[Abstract/Free Full Text]
  36. Poller L, Shiach CR, MacCallum PK, et al. Multicentre randomised study of computerised anticoagulant dosage. Lancet. 1998;352:1505–1509[CrossRef][Web of Science][Medline]
  37. Fitzmaurice DA, Hobbs FD, Delaney BC, et al. Review of computerised decision support systems for oral anticoagulation management. Br J Haematol. 1998;102:907–909[CrossRef][Web of Science][Medline]
  38. Taylor FC, Gray A, Cohen H, et al. Cost and effectiveness of a nurse specialist anticoagulant service. J Clin Pathol. 1997;50:823–828[Abstract/Free Full Text]
  39. Watzke HH, Forberg E, Svolba G, et al. A prospective controlled trial comparing weekly self-testing and self-dosing with the standard management of patients on stable oral anticoagulation. Thromb Haemost. 2000;83:661–665[Web of Science][Medline]
  40. Beyth RJ, Quinn L, Landefeld CS. A multicomponent intervention to prevent major bleeding complications in older patients receiving warfarin. A randomized, controlled trial. Ann Intern Med. 2000;133:687–695[Abstract/Free Full Text]
  41. Man-Son-Hing M, Laupacis A, O'Connor AM, et al. A patient decision aid regarding antithrombotic therapy for stroke prevention in atrial fibrillation: a randomized controlled trial. JAMA. 1999;282:737–743[Abstract/Free Full Text]
  42. Thomson R, Parkin D, Eccles M, et al. Decision analysis and guidelines for anticoagulant therapy to prevent stroke in patients with atrial fibrillation. Lancet. 2000;355:956–962[CrossRef][Web of Science][Medline]
  43. Morocutti C, Amabile G, Fattapposta F, et al. Indobufen versus warfarin in the secondary prevention of major vascular events in nonrheumatic atrial fibrillation. SIFA (Studio Italiano Fibrillazione Atriale) Investigators. Stroke. 1997;28:1015–1021[Abstract/Free Full Text]
  44. Diener HC, Cunha L, Forbes C, et al. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci. 1996;143:1–13[CrossRef][Web of Science][Medline]
  45. Camm AJ. Atrial fibrillation: is there a role for low-molecular-weight heparin? Clin Cardiol. 2001;24(3):115–119
  46. Harenberg J, Weuster B, Pfitzer M, et al. Prophylaxis of embolic events in patients with atrial fibrillation using low molecular weight heparin. Semin Thromb Hemost. 1993;19(Suppl 1):116–121
  47. Sievert H, Lesh MD, Trepels T, et al. Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation: early clinical experience. Circulation. 2002;105:1887–1891[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Villani, G.Q.
Right arrow Articles by Capucci, A.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Villani, G.Q.
Right arrow Articles by Capucci, A.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?