Document Detail


Anticoagulation in atrial fibrillation: selected controversies including optimal anticoagulation intensity, treatment of intracerebral hemorrhage.
MedLine Citation:
PMID:  17906918     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Clinical trials during the past 20 years have revolutionized the antithrombotic management of atrial fibrillation. Based on consideration of 30 randomized trials involving 29,017 participants, adjusted-dose warfarin remains the most efficacious prophylaxis against stroke for atrial fibrillation patients at moderate-to-high risk (compared with antiplatelet agents, warfarin reduces stroke by about 40%). The optimal INR for prevention of stroke for most atrial fibrillation patients is probably 2.0-2.5; INRs of 1.6-1.9 provide substantial protection, 80-90% of that afforded by higher intensities. Warfarin-associated intracerebral hemorrhage is an increasing problem as more elderly patients with atrial fibrillation are anticoagulated. Modest reductions in blood pressure results in large decreases in this most dreaded complication of warfarin; anticoagulation of elderly atrial fibrillation patients should be accompanied by a firm commitment to control hypertension. Warfarin-associated intracerebral hemorrhage has a 50% early mortality. A wide range of acute treatments to urgently reverse anticoagulation have been recommended by experts, but prevention is a far better option than treatment of this devastating problem.
Authors:
Robert G Hart; Maria I Aguilar
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Publication Detail:
Type:  Journal Article; Review     Date:  2007-09-29
Journal Detail:
Title:  Journal of thrombosis and thrombolysis     Volume:  25     ISSN:  0929-5305     ISO Abbreviation:  J. Thromb. Thrombolysis     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-01-07     Completed Date:  2008-03-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9502018     Medline TA:  J Thromb Thrombolysis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  26-32     Citation Subset:  IM    
Affiliation:
Department of Medicine (Neurology), University of Texas Health Science Center, San Antonio, TX 78229, USA. hartr@uthscsa.edu
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / adverse effects,  therapeutic use*
Atrial Fibrillation / drug therapy*
Cerebral Hemorrhage / chemically induced,  drug therapy*,  etiology
Humans
Hypertension / complications
Stroke / etiology,  prevention & control
Warfarin
Chemical
Reg. No./Substance:
0/Anticoagulants; 81-81-2/Warfarin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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