Stroke prevention in atrial fibrillation: warfarin faces its challengers.
Warfarin is exceedingly effective and underutilized in treating atrial fibrillation. Recently completed studies of alternative therapies include trials of ximelagatran versus warfarin, antiplatelet therapy plus lower-intensity warfarin versus usual warfarin, and strategies of rhythm versus rate control. Results of these studies suggest new options for treatment, and caveats regarding those who appear to have durable sinus rhythm. Ongoing trials include studies of combined antiplatelet therapy and other antithrombins. Nonpharmacologic approaches include the Maze III procedure and similar operations, left atrial appendage obliteration, and catheter-based radiofrequency ablation procedures. The place of these latter therapies will only be defined through subsequent clinical trials.
Blackshear
Joseph L
JL
Mayo Clinic-Jacksonville, 4500 San Pablo Road, Jacksonville, FL 32224, USA. blackshear.joseph@mayo.edu
Kusumoto
Fred
F
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000628:therapy*; D017115:Catheter Ablation; D002986:Clinical Trials as Topic; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D012307:Risk Factors; D020521:Stroke / Q000139:chemically induced / Q000517:prevention & control*; D013923:Thromboembolism / Q000139:chemically induced / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use
D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014859:Warfarin