Preventing stroke in patients with nonrheumatic atrial fibrillation

K. M. Nelson, Robert Talbert

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Published and ongoing studies of drug therapy for preventing stroke in patients with nonrheumatic atrial fibrillation (AF) are discussed, and updated recommendations are provided. Stroke is the most common complication of nonrheumatic AF; there are more than 75,000 such strokes each year in North America. Nonrheumatic AF increases the risk of stroke almost sixfold. Emboli from clots that form in the left atrium because of ineffective atrial contraction and turbulent blood flow may cause most of these strokes. The results of six randomized trials of antithrombotic therapy in patients with nonrheumatic AF are now available. In almost all of these trials, warfarin therapy significantly reduced the risk of stroke. One trial showed that aspirin significantly reduced the risk of stroke, but another trial did not support that finding. Ongoing trials are addressing the efficacy and risks of aspirin plus low-dose warfarin and very low intensity anticoagulation. Overall, the data suggest that patients who are younger than 75 years of age and who lack risk factors can be adequately protected against stroke with aspirin. Patients younger than 75 years who have risk factors but no contraindications to warfarin should receive warfarin. Patients older than 75 years appear to benefit from anticoagulation therapy, but this benefit is offset by the higher risk of bleeding complications. Lone AF is best managed with aspirin. Warfarin is superior to aspirin as a secondary intervention in patients with a recent thromboembolic event. Strategies for preventing stroke in patients with nonrheumatic atrial fibrillation continue to be refined.

Original languageEnglish (US)
Pages (from-to)1175-1183
Number of pages9
JournalAmerican Journal of Hospital Pharmacy
Volume51
Issue number9
StatePublished - 1994

Fingerprint

Atrial Fibrillation
Stroke
Warfarin
Aspirin
North America
Embolism
Heart Atria
Therapeutics
Hemorrhage
Drug Therapy

Keywords

  • Age
  • Anticoagulants
  • Aspirin
  • Atrial fibrillation
  • Cerebrovascular disorders
  • Clinical studies
  • Geriatrics
  • Hemorrhage
  • Platelet aggregation inhibitors
  • Toxicity
  • Warfarin

ASJC Scopus subject areas

  • Leadership and Management
  • Pharmaceutical Science

Cite this

Preventing stroke in patients with nonrheumatic atrial fibrillation. / Nelson, K. M.; Talbert, Robert.

In: American Journal of Hospital Pharmacy, Vol. 51, No. 9, 1994, p. 1175-1183.

Research output: Contribution to journalArticle

Nelson, K. M. ; Talbert, Robert. / Preventing stroke in patients with nonrheumatic atrial fibrillation. In: American Journal of Hospital Pharmacy. 1994 ; Vol. 51, No. 9. pp. 1175-1183.
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