[Prevention of ischemic stroke in middle aged patients with atrial fibrillation. Effect of sinus rhythm maintenance, aspirin, warfarin, and simvastatin].
Patients (n=263, age 49-64 years) with persistent nonvalvular atrial fibrillation were subjected to controlled treatment aimed at restoration and maintenance of sinus rhythm (n=134) or slowing of rate of ventricular contractions. Efficacy of complementary use of combination of simvastatin with aspirin, warfarin and aspirin for prevention of ischemic stroke was assessed in both of these strategies. First strategy, supplemented with combination of simvastatin and aspirin prevented ischemic stroke and lethal outcome most successfully, while the use of warfarin was unexpectedly associated with comparative elevation of risk of ischemic stroke. It is impossible to exclude that long term administration of warfarin in strategy of sinus rhythm maintenance attenuated advantages of normal rhythm in relation of lowering of stroke risk in AFFIRM study and other similar works. Contrary to known cardio-embolic mechanism of cerebral embolism in permanent atrial fibrillation main aim of the treatment in successful sinus rhythm maintenance may become prevention of arterio-arterial emboli.
Kanorskiĭ
S G
SG
Shevelev
V I
VI
Zafiraki
V K
VK
Zingilevskiĭ
K B
KB
D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019821:Simvastatin / Q000627:therapeutic use*; D012849:Sinoatrial Node / Q000187:drug effects / Q000503:physiopathology*; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D019821:Simvastatin; D001241:Aspirin