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Anticoagulation in Atrial Fibrillation: Is Aspirin Sufficient?

  • G. Di Pasquale
  • S. Urbinati
  • M. A. Ribani
  • P. Passarelli
  • G. Labanti
  • M. L. Borgatti
  • G. Pinelli
Conference paper

Abstract

Atrial fibrillation (AF) carries a high risk of systemic embolism, in particular stroke. This is true not only when AF is associated with rheumatic valvular disease, but also in the so-called nonvalvular AF (NVAF) (1–7).

Keywords

Atrial Fibrillation International Normalize Ratio Stroke Prevention Atrial Fibrillation Patient Systemic Embolism 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Halperin JL, Hart RG (1988) Atrial fibrillation and stroke: new ideas, persisting dilemmas (editorial). Stroke 19: 937–941PubMedCrossRefGoogle Scholar
  2. 2.
    Cerebral Embolism Task Force (1989) Cardiogenic brain embolism: the second report of the Cerebral Embolism Task Force. Arch Neurol 46: 727–743CrossRefGoogle Scholar
  3. 3.
    Petersen P (1990) Thromboembolic complications in atrial fibrillation. Stroke 21: 4–13PubMedCrossRefGoogle Scholar
  4. 4.
    Cairns JA, Connolly SJ (1991) Nonrheumatic atrial fibrillation. Risk of stroke and role of antithrombotic therapy. Circulation 84: 469–481PubMedGoogle Scholar
  5. 5.
    Hart RG (1992) Thromboembolism in nonrheumatic atrial fibrillation: what have we learned? In: Di Pasquale G, Pinelli G (eds) Heart-brain interactions. Springer, Berlin Heidelberg New York, pp 83–86CrossRefGoogle Scholar
  6. 6.
    The National Heart, Lung and Blood Institute Working Group on Atrial Fibrillation (1993) Atrial fibrillation: current understandings and research imperatives. J Am Coll Cardiol 32: 1830–1834Google Scholar
  7. 7.
    Hart RG, Halperin JL (1994) Atrial fibrillation and stroke: revisiting the dilemmas. Stroke 25: 1337–1341PubMedCrossRefGoogle Scholar
  8. 8.
    Stein B, Fuster V, Halperin JL, Chesebro JH (1989) Antithrombotic therapy in cardiac disease. An emerging approach based on pathogenesis and risk. Circulation 80: 1501–1513PubMedCrossRefGoogle Scholar
  9. 9.
    Chesebro JH, Fuster V, Halperin JL (1991) Atrial fibrillation: risk marker for stroke. N Engl J Med 323: 1556–1558CrossRefGoogle Scholar
  10. 10.
    Petersen P, Boysen G, Godtfredsen J, Andersen ED, Andersen B (1989) Placebo-controlled, randomised trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK Study. Lancet 1: 175–179CrossRefGoogle Scholar
  11. 11.
    The Stroke Prevention in Atrial Fibrillation Investigators (1991) The Stroke Prevention in Atrial Fibrillation trial: final results. Circulation 84: 527–539Google Scholar
  12. 12.
    The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators (1990) The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation. N Engl J Med 325: 1505–1511Google Scholar
  13. 13.
    Connolly SJ, Laupacis A, Gent M, Roberts RS, Cairns JA, Joyner C, for the CAFA study coinvestigators (1991) Canadian Atrial Fibrillation Anticoagulation ( CAFA) study. J Am Coll Cardiol 18: 349–355PubMedCrossRefGoogle Scholar
  14. 14.
    Ezeckowitz MD, Bridgers SL, James KE, Carliner NH, Colling CL, Gornick CC, Krause-Steinrauf H, Kurtzke JF, Nazarian SM, Radford MJ, Rickles FR, Shabetai R, Deykin D, for the Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators (1992) Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. N Engl J Med 327: 1406–1412Google Scholar
  15. 15.
    The Stroke Prevention in Atrial Fibrillation Investigators (1992) Predictors of thromboembolism in atrial fibrillation: I. clinical features of patients at risk. Ann Intern Med 116: 1–5Google Scholar
  16. 16.
    Atrial Fibrillation Investigators (1994) Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials. Arch Intern Med 154: 1449–1457CrossRefGoogle Scholar
  17. 17.
    Di Pasquale G, Urbinati S, Ribani MA, Passarelli P, Pinelli G (1994) Clinical markers of embolic risk in patients with atrial fibrillation. G Ital Cardiol 24: 315–324PubMedGoogle Scholar
  18. 18.
    Kopecky 51, Gersh BJ, Mc Goon MD, Whisnant JP, Holmes DR Jr, Ilstrup DM, Frye RL (1987) The natural history of lone atrial fibrillation: a population-based study over three decades. N Engl J Med 327: 1406–1412Google Scholar
  19. 19.
    The Stroke Prevention in Atrial Fibrillation Investigators (1992) Predictors of thromboembolism in atrial fibrillation: II. echocardiographic features of patients at risk. Ann Intern Med 116: 6–12Google Scholar
  20. 20.
    Di Pasquale G, Urbinati S, Pinelli G (1995) New echocardiographic markers of embolic risk in atrial fibrillation. Cerebrovasc Dis (in press)Google Scholar
  21. 21.
    Albers G, Atwood JE, Hirsch J, Sherman DG, Hughes RA, Connolly SJ (1991) Stroke prevention in nonvalvular atrial fibrillation. Ann Intern Med 115: 727–736PubMedGoogle Scholar
  22. 22.
    Laupacis A, Albers G, Dunn M, Feinberg W (1992) Antithrombotic therapy in atrial fibrillation. Chest 102 [Suppl]: 426S - 433SPubMedCrossRefGoogle Scholar
  23. 23.
    Stroke Prevention in Atrial Fibrillation Investigators (1994) Warfarin versus aspirin for prevention of thromboembolism in atrial fibrilllation: Stroke Prevention in Atrial Fibrillation II Study. Lancet 346: 687–691Google Scholar
  24. 24.
    EAFT (European Atrial Fibrillation Trial) Study Group (1993) Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 342: 1255–1262Google Scholar
  25. 25.
    Patrono C (1994) Aspirin as an antiplatelet drug. N Engl J Med 330: 1287–1294PubMedCrossRefGoogle Scholar
  26. 26.
    Singer DE, Hughes RA, Gress DR, Sheehan MA, Oertel LB, Maraventano SW, Blewett DR, Rosner B, Kistler JP for the BAATAF Investigators (1992) The effect of aspirin on the risk of stroke in patients with nonrheumatic atrial fibrillation: the BAATAF Study. Am Heart J 124: 1567–1573Google Scholar
  27. 27.
    Mc Anulty JH, Hart RG, Pearce RA for the SPAF Investigators (1993) Atrial fibrillation and thromboembolism: predictors of high risk during aspirin therapy. Circulation 88 [suppl]: 1–222 (abstr)Google Scholar
  28. 28.
    Bornstein NM, Karepov VG, Aronovich BD, Gorbulev AY, Treves TA, Korczyn AD (1994) Failure of aspirin treatment after stroke. Stroke 25: 275–277PubMedCrossRefGoogle Scholar
  29. 29.
    Canadian Cooperative Study Group (1978) A randomized trial of aspirin and sulfinpyrazone in threatened stroke. N Engl J Med 299: 53–59CrossRefGoogle Scholar
  30. 30.
    UK-TIA Study Group (1988) United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: interim results. Br Med J 296: 316–320CrossRefGoogle Scholar
  31. 31.
    Antiplatelet Trialists’ Collaboration (1994) Collaborative overview of randomized trials of antiplatelet therapy–I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Br Med J 306: 81–106Google Scholar
  32. 32.
    Flegel KM, Hanley J (1989) Risk factors for stroke and other embolic events in patients with nonrheumatic atrial fibrillation. Stroke 20: 1000–1004PubMedCrossRefGoogle Scholar
  33. 33.
    Moulton AW, Singer DE, Haas JS (1991) Risk factors for stroke in patients with nonrheumatic atrial fibrillation: a case-control study. Am J Med 91: 156–161PubMedCrossRefGoogle Scholar
  34. 34.
    Corbalan R, Arriagada D, Braun S, Tapia J, Huete I, Kramer A, Chavez A (1992) Risk factors for systemic embolism in patients with paroxysmal atrial fibrillation. Am Heart J 124: 149–153PubMedCrossRefGoogle Scholar
  35. 35.
    Di Pasquale G, Andreoli A, Lusa AM, Urbinati S, Grazi P, Carini GC, Ruffini M, Pinelli G (1990) Cerebral embolic risk in hypertrophie cardiomyopathy. In: Baroldi G, Camerini F, Goodwin JF (eds) Advances in cardiomyopathies. Springer, Berlin Heidelberg New York, pp 90–96CrossRefGoogle Scholar
  36. 36.
    Major Ongoing Stroke Trials (1995) Stroke 26: 349–353Google Scholar
  37. 37.
    Miller VT, Rothrock JF, Pearce LA, Feinberg WM, Hart RG, Anderson DC (1993) Ischemic stroke in patients with atrial fibrillation: clinical characteristics and the effect of aspirin. Neurology 43: 32–36PubMedGoogle Scholar
  38. 38.
    Grotemeyer KH (1991) Effect of acetylsalicylic acid in stroke patients. Evidence of nonresponders in a subpopulation of treated patients. Thromb Res 63: 587–593PubMedCrossRefGoogle Scholar
  39. 39.
    Fornaro GL, Rossi P, Mantica P, Caccia ME, Aralda D, Lavezzari M, Pamparana F, Milanesi G (1993) Indobufen in the prevention of thromboembolic complications in patients with heart disease. A randomized, placebo-controlled, double-blind study. Circulation 87: 162–164PubMedGoogle Scholar
  40. 40.
    Cataldo G, SIFA Study Group (1995) Secondary prevention of stroke in non-valvular atrial fibrillation: results of the SIFA (Studio Italiano Fibrillazione Atriale). J Am Coll Cardiol 25 [Suppl] 144A (abstr)Google Scholar
  41. 41.
    Gustafsson C, Blombäck M, Britton M, Hamsten A, Svensson J (1990) Coagulation factors and the increased risk of stroke in nonvalvular atrial fibrillation. Stroke 21: 47–51PubMedCrossRefGoogle Scholar
  42. 42.
    Kumagai K, Fukunami M, Ohmori M, Kitabatake A, Kamada T, Hoki N (1990) Increased intracardiovascular clotting in patients with chronic atrial fibrillation. J Am Coll Cardiol 16: 377–380PubMedCrossRefGoogle Scholar
  43. 43.
    Boysen G, Petersen P, Felding P (1991) Coagulation and fibrinolysis in patients with chronic atrial fibrillation. Cerebrovasc Dis 1: 235–238CrossRefGoogle Scholar
  44. 44.
    Yamamoto K, Ikeda V, Seino Y, Mito H, Fujikawa H, Sekiguchi H, Shimada K (1995) Coagulation activity is increased in the left atrium of patients with mitral stenosis. J Am Coll Cardiol 25: 1107–1112Google Scholar
  45. 45.
    Di Pasquale G, Ribani MA, Urbinati S, Passarelli P, Pinelli G (1995) Come si deve trattare oggi la fibrillazione atriale. In: Prati PL (ed) Conoscere e curare it cuore ‘85. CIBA Edizioni, Milan, pp 285–299Google Scholar

Copyright information

© Springer-Verlag Italia, Milano 1996

Authors and Affiliations

  • G. Di Pasquale
    • 1
  • S. Urbinati
    • 1
  • M. A. Ribani
    • 1
  • P. Passarelli
    • 1
  • G. Labanti
    • 1
  • M. L. Borgatti
    • 1
  • G. Pinelli
    • 1
  1. 1.Divisione di CardiologiaOspedale BellariaBolognaItaly

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