Document Detail


The increasing need for anticoagulant therapy to prevent stroke in patients with atrial fibrillation.
MedLine Citation:
PMID:  15244388     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Ischemic stroke, a major complication of atrial fibrillation (AF), is believed to result from atrial thrombus formation caused by ineffective atrial contraction. Oral anticoagulant therapy effectively reduces the risk of ischemic stroke in patients with AF; this therapy is recommended for patients with any frequency or duration of AF and other risk factors for stroke, such as increased age (>75 years), hypertension, prior stroke, left ventricular dysfunction, diabetes, or heart failure. Recently published data comparing rate-control and rhythm-control strategies in AF emphasized the importance of maintaining an international normalized ratio higher than 2.0 during warfarin therapy and the need for continuing anticoagulant therapy to prevent stroke in high-risk patients, even if the strategy is rhythm control. Hemorrhagic complications can be minimized by stringent control of the international normalized ratio (particularly in elderly patients) and appropriate therapy for comorbidities such as hypertension, gastric ulcer, and early-stage cancers. Undertreatment of patients with AF is a continuing problem, particularly in the elderly population. Patients perceived as likely to be noncompliant, such as the functionally impaired, are less likely to receive warfarin therapy. However, stroke prevention with anticoagulants is cost-effective and improves quality of life, despite the challenges of maintaining appropriate anticoagulation with monitoring and warfarin dose titration. New medications in development with more predictable dosing and fewer drug-drug interactions may reduce the complexities of achieving optimal anticoagulation and increase the practicality of long-term anticoagulant therapy for patients with AF at risk of stroke.
Authors:
Michael D Ezekowitz; Rodney H Falk
Related Documents :
20491018 - Baseline characteristics of patients from poland enrolled in the global registry of pat...
14760918 - Frequency measures obtained from the surface electrocardiogram in atrial fibrillation r...
16500298 - Efficacy of catheter ablation of atrial fibrillation in patients with hypertrophic obst...
11167228 - Conjunctival papilloma. a histopathologically based retrospective study.
10882848 - Abnormal levels of camp-dependent protein kinase regulatory subunits in platelets from ...
2916358 - Cytologic features of endometrial papillary serous carcinoma.
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Mayo Clinic proceedings     Volume:  79     ISSN:  0025-6196     ISO Abbreviation:  Mayo Clin. Proc.     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-07-12     Completed Date:  2004-07-27     Revised Date:  2013-12-13    
Medline Journal Info:
Nlm Unique ID:  0405543     Medline TA:  Mayo Clin Proc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  904-13     Citation Subset:  AIM; IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Anticoagulants / administration & dosage,  adverse effects,  therapeutic use*
Atrial Fibrillation / complications*
Cerebral Hemorrhage / chemically induced
Humans
Stroke / prevention & control*
Warfarin / administration & dosage,  adverse effects
Chemical
Reg. No./Substance:
0/Anticoagulants; 5Q7ZVV76EI/Warfarin

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


Previous Document:  Clinicoradiological features of pulmonary infarctions mimicking lung cancer.
Next Document:  An algorithm for the management of restless legs syndrome.