Atrial fibrillation and thromboembolic stroke.
Long-term oral warfarin should be administered to patients with atrial fibrillation who have a history of systemic embolism, mitral valve disease, nonvalvular atrial fibrillation, or mitral annular calcium to reduce the incidence of thromboembolic stroke. Aspirin 325 mg/d may be given to patients with non-valvular atrial fibrillation who have contraindications to warfarin and to patients with nonvalvular atrial fibrillation younger than 75 years of age who have a low risk of systemic thromboembolism. Patients with lone atrial fibrillation younger than 60 years of age should not receive anticoagulants. However, low-dose oral warfarin should be given to elderly patients with lone atrial fibrillation. Digoxin, verapamil, diltiazem, and propranolol may be used to control ventricular rate in atrial fibrillation. I would not routinely use antiarrhythmic drugs but would use propranolol in patients with atrial fibrillation with ventricular arrhythmias or after conversion of atrial fibrillation to sinus rhythm.
Aronow
W S
WS
Hebrew Hospital Home, Bronx, NY 10475.
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy; D002908:Chronic Disease; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000209:etiology* / Q000517:prevention & control; D008875:Middle Aged; D012307:Risk Factors