Anticoagulation to prevent stroke in atrial fibrillation and its implications for managed care.
A Symposium : Treatment of Atrial Fibrillation in the Era of Managed Care. New York, NY, USA, 1996/08/17.
Nonrheumafic atrial fibrillation (AFib) is the most potent common risk factor for stroke, raising the risk of stroke 5-fold.
Six randomized trials of anticoagulation in AFib consistently demonstrated a reduction in the risk of stroke by about two-thirds.
In these trials, anticoagulation in AFib was quite safe.
In contrast, randomized trials indicate that aspirin confers only a small reduction in risk of stroke, at best.
Pooled data from the first set of randomized trials indicate that prior stroke, hypertension, diabetes, and increasing age are independent risk factors for future stroke with AFib.
Individuals<65 years old with none of the other risk factors might safely avoid anticoagulation ; for all others, anticoagulation seems indicated.
Studies of hemorrhagic risk highlight the importance of keeping the international normalized ratio (INR)<4.0. Recent analyses also reveal that risk of ischemic stroke in AFib increases greatly at INR levels<2.0. Efficacy and safety of anticoagulation in AFib depend on maintaining the INR between 2.0-3.0. Costeffectiveness studies indicate that anticoagulation for AFib is among the most efficient preventive interventions in adult importantly, the benefits of anticoagulation in AFib accrue immediately. (...)
Mots-clés Pascal : Fibrillation auriculaire, Accident cérébrovasculaire, Anticoagulant, Soin intégré, Organisation santé, Chimiothérapie, Traitement, Prévention, Complication, Homme, Appareil circulatoire pathologie, Cardiopathie, Trouble rythme cardiaque, Trouble excitabilité, Système nerveux pathologie, Système nerveux central pathologie, Encéphale pathologie, Cérébrovasculaire pathologie, Vaisseau sanguin pathologie
Mots-clés Pascal anglais : Atrial fibrillation, Stroke, Anticoagulant, Managed care, Public health organization, Chemotherapy, Treatment, Prevention, Complication, Human, Cardiovascular disease, Heart disease, Arrhythmia, Excitability disorder, Nervous system diseases, Central nervous system disease, Cerebral disorder, Cerebrovascular disease, Vascular disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0275614
Code Inist : 002B02G. Création : 27/11/1998.