Document Detail


Atrial fibrillation and stroke: four treatment controversies.
MedLine Citation:
PMID:  16221372     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
Atrial fibrillation is an important cause of disabling ischemic stroke, and adjusted-dose warfarin is highly effective for prevention and remains the therapy of choice for high-risk patients. Ximelagatran, a novel oral anticoagulant, is clinically equivalent to warfarin for preventing stroke in patients with atrial fibrillation, but concerns about potential hepatic toxicity have precluded US Food and Drug Administration approval. Many patients with low-risk atrial fibrillation do not benefit substantially from anticoagulation, and these patients can be reliably identified using the CHADS2 stroke risk stratification scheme. A target International Normalized Ratio (INR) range of 2 to 3 is usually recommended for anticoagulation of patients with atrial fibrillation, but a lower INR target (2, range 1.6-2.5) may be a reasonable benefit/risk trade-off for primary prevention in those aged older than 75 years. Adding aspirin to adjusted-dose anticoagulation increases bleeding (including central nervous system bleeding), is of uncertain value, and should only be done after careful consideration and with vigorous efforts to control blood pressure.
Authors:
Robert G Hart
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current treatment options in neurology     Volume:  7     ISSN:  1092-8480     ISO Abbreviation:  Curr Treat Options Neurol     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-10-13     Completed Date:  2006-01-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815940     Medline TA:  Curr Treat Options Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  491-8     Citation Subset:  -    
Affiliation:
University of Texas Health Science Center, 7703 Floyd Curl Drive, MC# 7883, San Antonio, TX 78229, USA. hartr@uthscsa.edu
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