What Is the Best Practical Scheme for Initiating Oral Anticoagulant Treatment in Outpatients with Atrial Fibrillation?

摘要

Patients with atrial fibrillation (AF) have an approximately four-fold increased risk of stroke and systemic embolism [1]. Generally thrombus forms in the left atrial appendage because of the relative inactivity of the atria during AF [2]. The risk of stroke exists in all patients with AF, but the incidence of stroke is related to coexistent cardiovascular disease, hypertension, diabetes, or previous stroke [3,4]. Advancing age is associated with increased stroke risk, probably due to the effect of left atrium enlargement and left ventricular diastolic dysfunction, frequently observed in elderly patients [5, 6]. Nearly half of AF-associated strokes occur in patients older than 75 years.Antithrombotic strategy for prevention of stroke and systemic embolism is based on the results of large randomized trials which showed that adjusted-dose oral anticoagulation with warfarin is highly efficacious in preventing stroke, with a risk reduction of 68(percent) versus placebo [7]. This reduction is similar for both primary and secondary prevention.