Premium
Non‐valvular atrial fibrillation and stroke prevention
Author(s) -
Hankey Graeme J
Publication year - 2001
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2001.tb143246.x
Subject(s) - medicine , atrial fibrillation , stroke (engine) , warfarin , aspirin , cardiology , sinus rhythm , anticoagulant , diabetes mellitus , concomitant , mechanical engineering , engineering , endocrinology
Atrial fibrillation (AF) affects 5% of people older than 65 years. Among patients with AF, the risk of stroke averages about 5% per year. The risk of stroke increases cumulatively with increasing age, previous transient ischaemic attack or stroke, hypertension, diabetes, impaired left ventricular function and a large left atrium. Management aims to identify and treat the underlying cause, control the ventricular rate, restore and maintain Sinus rhythm, and minimise the risk of stroke. Warfarin reduces the risk of stroke by about two‐thirds and aspirin by about one‐fifth. The risk of anticoagulant‐associated haemorrhage increases with serious concomitant disease, and with poorly controlled hypertension and poorly controlled anticoagulation. All patients with chronic AF should be considered for oral anticoagulant therapy, and the decision based on the balance between the risks of thromboembolism at blooding. The recommended INR (international normalised ratio) is 2.0–3.0. Treating 1000 “average” AF patients (ie, those with a 5% per year risk of stroke) with warfarin prevents about 30 strokes and causes at least two episodes of major haemorrhage each year. Treating 1000 AF patients with aspirin prevents about 15 strokes each year.