Antithrombotic therapy for stroke prevention in atrial fibrillation.
Atrial fibrillation (AF) is the most potent common risk factor for ischemic stroke. The number of Americans with nonvalvular AF is expected to increase markedly over the next several decades, making AF-related stroke an important public health concern. Given the individual and societal burden associated with AF-related stroke, efforts to identify and implement efficacious and acceptably safe therapeutic stroke prevention strategies are paramount. This article reviews the existing randomized trial evidence supporting the efficacy of oral vitamin K antagonists (ie, warfarin) or aspirin for preventing thromboembolism in AF, as well as completed and ongoing studies exploring novel antithrombotic agents including the oral direct thrombin inhibitor, ximelagatran, other antiplatelet agents (eg, clopidogrel), factor Xa inhibitors, and other pharmacological agents and additional therapeutic approaches such as mechanical devices and surgical procedures to obliterate the left atrial appendage.
Go
Alan S
AS
Division of Research, Kaiser Permanente of Northern California, 2000 Broadway St, 3rd Floor, Oakland, CA 94612-2304, USA. alan.s.go@kp.org
Fang
Margaret C
MC
Singer
Daniel E
DE
D000925:Anticoagulants / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000628:therapy*; D006348:Cardiac Surgical Procedures; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors / Q000627:therapeutic use
D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D005343:Fibrinolytic Agents; D014812:Vitamin K; D001241:Aspirin