Oral anticoagulant therapy for patients with atrial fibrillation - an update

摘要

It is projected that 7.5 million individuals will haveatrial fibrillation (AF) in the United States by the year2020 [1]. The reason for this increasing prevalence ismultifactorial and due in part to the increasedprevalence of risk factors for AF like hypertension,heart failure, diabetes, obesity, and older age.Among individuals age 80 years and greater, theprevalence of AF is approximately 10 percent [2].Atrial fibrillation confers a five-fold increased risk ofstroke and 15 percent of all strokes occur in peoplewith AF. The attributable risk of stroke with AF differsby age, 1.5 percent for those 50 to 59 years versus23.5 percent for those 80 to 89 years. Untreated, theaverage rate of stroke per year is 5 percent [3]. Theglobal impact of stroke is enormous. It is the thirdmost common cause of death in developed countriesand the leading cause of serious long term disability.The disability adjusted life years are projected toreach 61 million years per 1,000 population by theyear 2020 which is significantly increased from38 million in 1990 [4]. The 30-day mortality of AFrelatedstroke has been shown in multiple studies toapproximate 23-25 percent [5].