(Stroke. 1999;30:1223-1229.)
© 1999 American Heart Association, Inc.
Original Contributions |
Factors Associated With Ischemic Stroke During Aspirin Therapy in Atrial Fibrillation
Analysis of 2012 Participants in the SPAF I–III Clinical Trials
From the University of Texas Health Science Center, San Antonio (R.G.H.); Statistics and Epidemiology Research Corporation, Seattle, Wash (L.A.P., R. McB.); LeBauer Cardiology Associates, Greensboro, NC (R.M.R.); and Hennepin County Medical Center, Minneapolis, Minn (R.W.A.), on behalf of the Stroke Prevention in Atrial Fibrillation (SPAF) Investigators.
Correspondence to Robert G. Hart, MD, Department of Medicine (Neurology), University of Texas Health Science Center, 7703 Floyd Curl Dr, San Antonio, TX 78284. E-mail HartR{at}uthscsa.edu
Background and Purpose—Nonvalvular atrial fibrillation (AF) is a strong, independent risk factor for stroke, but the absolute rate of stroke varies widely among AF patients, importantly influencing the potential benefit of antithrombotic prophylaxis. We explore factors associated with ischemic stroke in AF patients taking aspirin.
Methods—We performed multivariate logistic regression analysis of 2012 participants given aspirin alone or in combination with low, inefficacious doses of warfarin in the Stroke Prevention in Atrial Fibrillation I–III trials followed for a mean of 2.0 years, during which 130 ischemic strokes were observed.
Results—Age (relative risk [RR]=1.8 per decade,
P<0.001), female sex (RR=1.6,
P=0.01), history of hypertension (RR=2.0,
P<0.001), systolic blood pressure >160
mm Hg (RR=2.3, P<0.001), and prior stroke or transient
ischemic attack (RR=2.9, P<0.001) were
independently associated with increased stroke risk. Regular
consumption of 
14 alcohol-containing drinks per week was associated
with reduced stroke risk (adjusted RR=0.4, P=0.04).
Among SPAF III participants, estrogen hormone replacement therapy was
associated with a higher risk of ischemic stroke (adjusted
RR=3.2, P=0.007). With the use of these variables, a
risk stratification scheme for primary prevention separated
participants into those with high (7.1%/y, 22% of the cohort),
moderate (2.6%/y, 37% of the cohort), and low (0.9%/y, 41% of the
cohort) rates of stroke. Ischemic strokes in low-risk
participants were less often disabling (P<0.001).
Conclusions—Patients with AF who have high and low rates of stroke during treatment with aspirin can be identified. However, validation of our risk stratification scheme is necessary before it can be applied with confidence to clinical management. Postmenopausal estrogen replacement therapy and moderate alcohol consumption may additionally modify the risk of stroke in AF, but these findings require confirmation.
Key Words: atrial fibrillation • cerebral embolism • estrogens • risk factors • stroke prevention
This article has been cited by other articles:
 |
|
 |
|
  R. G. Hart and L. A. Pearce Current Status of Stroke Risk Stratification in Patients With Atrial Fibrillation Stroke, July 1, 2009; 40(7): 2607 - 2610. [Full Text] [PDF]
|
|
|
|
 |
|
 C N Pellegrini, E Vittinghoff, F Lin, S B Hulley, and G M Marcus Statin use is associated with lower risk of atrial fibrillation in women with coronary disease: the HERS trial Heart, May 1, 2009; 95(9): 704 - 708. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. L. Bailey, D. C. Scantlebury, and S. S. Smyth Thrombosis and Antithrombotic Therapy in Women Arterioscler Thromb Vasc Biol, March 1, 2009; 29(3): 284 - 288. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. A. Alsheikh-Ali and N.A. M. Estes III Anticoagulation Control in Atrial Fibrillation: Optimizing Risks and Benefits Circ Cardiovasc Qual Outcomes, November 1, 2008; 1(2): 72 - 73. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Manzano-Fernandez, F. J. Pastor, F. Marin, F. Cambronero, C. Caro, D. A. Pascual-Figal, I. P. Garrido, E. Pinar, M. Valdes, and G. Y. H. Lip Increased Major Bleeding Complications Related to Triple Antithrombotic Therapy Usage in Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Artery Stenting Chest, September 1, 2008; 134(3): 559 - 567. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. E. Singer, G. W. Albers, J. E. Dalen, M. C. Fang, A. S. Go, J. L. Halperin, G. Y. H. Lip, and W. J. Manning Antithrombotic Therapy in Atrial Fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 546S - 592S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Stroke Risk in Atrial Fibrillation Working Group Comparison of 12 Risk Stratification Schemes to Predict Stroke in Patients With Nonvalvular Atrial Fibrillation Stroke, June 1, 2008; 39(6): 1901 - 1910. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Stramba-Badiale Atrial fibrillation subtypes, risk of stroke, and antithrombotic therapy Eur. Heart J., April 1, 2008; 29(7): 840 - 842. [Full Text] [PDF]
|
|
|
|
 |
|
 M. L. Hansen, N. Gadsboll, G. H. Gislason, S. Z. Abildstrom, T. K. Schramm, F. Folke, J. Friberg, R. Sorensen, S. Rasmussen, H. E. Poulsen, et al. Atrial fibrillation pharmacotherapy after hospital discharge between 1995 and 2004: a shift towards beta-blockers Europace, April 1, 2008; 10(4): 395 - 402. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. C. Fang, A. S. Go, Y. Chang, L. Borowsky, N. K. Pomernacki, D. E. Singer, and for the ATRIA Study Group Comparison of Risk Stratification Schemes to Predict Thromboembolism in People With Nonvalvular Atrial Fibrillation J. Am. Coll. Cardiol., February 26, 2008; 51(8): 810 - 815. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N.A. M. Estes III, J. L. Halperin, H. Calkins, M. D. Ezekowitz, P. Gitman, A. S. Go, R. L. McNamara, J. V. Messer, J. L. Ritchie, S. J.W. Romeo, et al. ACC/AHA/Physician Consortium 2008 Clinical Performance Measures for Adults With Nonvalvular Atrial Fibrillation or Atrial Flutter: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation) Developed in Collaboration With the Heart Rhythm Society J. Am. Coll. Cardiol., February 26, 2008; 51(8): 865 - 884. [Full Text] [PDF]
|
|
|
|
 |
|
 N. A. M. Estes III, J. L. Halperin, H. Calkins, M. D. Ezekowitz, P. Gitman, A. S. Go, R. L. McNamara, J. V. Messer, J. L. Ritchie, S. J.W. Romeo, et al. ACC/AHA/Physician Consortium 2008 Clinical Performance Measures for Adults With Nonvalvular Atrial Fibrillation or Atrial Flutter: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation) Circulation, February 26, 2008; 117(8): 1101 - 1120. [Full Text] [PDF]
|
|
|
|
 |
|
 E. A. Nutescu ASHP Therapeutic Position Statement on Antithrombotic Therapy in Chronic Atrial Fibrillation Am. J. Health Syst. Pharm., November 1, 2007; 64(21): 2281 - 2291. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Hughes, G.Y.H. Lip, and on behalf of the Guideline Development Group for t Risk factors for anticoagulation-related bleeding complications in patients with atrial fibrillation: a systematic review QJM, October 1, 2007; 100(10): 599 - 607. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Baruch, B. F. Gage, J. Horrow, S. Juul-Moller, A. Labovitz, M. Persson, and M. Zabalgoitia Can Patients at Elevated Risk of Stroke Treated With Anticoagulants Be Further Risk Stratified? Stroke, September 1, 2007; 38(9): 2459 - 2463. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 The Stroke Risk in Atrial Fibrillation Working Gro Independent predictors of stroke in patients with atrial fibrillation: A systematic review Neurology, August 7, 2007; 69(6): 546 - 554. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Thomson, M. Eccles, R. Wood, and D. J. Chinn A Cautionary Note on Data Sources for Evidence-Based Clinical Decisions: Warfarin and Stroke Prevention Med Decis Making, August 1, 2007; 27(4): 438 - 447. [Abstract] [PDF]
|
|
|
|
|
|
G. B. Forleo, C. Tondo, L. De Luca, A. D. Russo, M. Casella, V. De Sanctis, F. Clementi, R. L. Fagundes, R. Leo, F. Romeo, et al. Gender-related differences in catheter ablation of atrial fibrillation Europace, August 1, 2007; 9(8): 613 - 620. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. L. Glazer, S. Dublin, N. L. Smith, B. French, L. A. Jackson, J. B. Hrachovec, D. S. Siscovick, B. M. Psaty, and S. R. Heckbert Newly Detected Atrial Fibrillation and Compliance With Antithrombotic Guidelines Arch Intern Med, February 12, 2007; 167(3): 246 - 252. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Dagres, R. Nieuwlaat, P. E. Vardas, D. Andresen, S. Levy, S. Cobbe, D. Th. Kremastinos, G. Breithardt, D. V. Cokkinos, and H. J.G.M. Crijns Gender-Related Differences in Presentation, Treatment, and Outcome of Patients With Atrial Fibrillation in Europe: A Report From the Euro Heart Survey on Atrial Fibrillation J. Am. Coll. Cardiol., February 6, 2007; 49(5): 572 - 577. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. L. Flaherty, B. Kissela, D. Woo, D. Kleindorfer, K. Alwell, P. Sekar, C. J. Moomaw, M. Haverbusch, and J. P. Broderick The increasing incidence of anticoagulant-associated intracerebral hemorrhage Neurology, January 9, 2007; 68(2): 116 - 121. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. Van den Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) Eur. Heart J., January 1, 2007; 28(1): 88 - 136. [Full Text] [PDF]
|
|
|
|
|
|
Writing Committee Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Europace, September 1, 2006; 8(9): 651 - 745. [Full Text] [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society J. Am. Coll. Cardiol., August 15, 2006; 48(4): 854 - 906. [Full Text] [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society J. Am. Coll. Cardiol., August 15, 2006; 48(4): e149 - e246. [Full Text] [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society Circulation, August 15, 2006; 114(7): e257 - e354. [Full Text] [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, J. E. Lowe, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society Circulation, August 15, 2006; 114(7): 700 - 752. [Full Text] [PDF]
|
|
|
|
|
|
Authors/Task Force Members, V. Fuster, L. E. Ryden, D. S. Cannom, H. J. Crijns, A. B. Curtis, K. A. Ellenbogen, J. L. Halperin, J.-Y. Le Heuzey, G. N. Kay, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society Eur. Heart J., August 2, 2006; 27(16): 1979 - 2030. [Full Text] [PDF]
|
|
|
|
|
|
G. Y.H. Lip, T. Watson, and E. Shantsila Anticoagulation for stroke prevention in atrial fibrillation: is gender important? Eur. Heart J., August 2, 2006; 27(16): 1893 - 1894. [Full Text] [PDF]
|
|
|
|
|
|
P. S. Chan, S. Vijan, F. Morady, and H. Oral Cost-Effectiveness of Radiofrequency Catheter Ablation for Atrial Fibrillation J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2513 - 2520. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Goldstein, R. Adams, M. J. Alberts, L. J. Appel, L. M. Brass, C. D. Bushnell, A. Culebras, T. J. DeGraba, P. B. Gorelick, J. R. Guyton, et al. Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline. Circulation, June 20, 2006; 113(24): e873 - e923. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Goldstein, R. Adams, M. J. Alberts, L. J. Appel, L. M. Brass, C. D. Bushnell, A. Culebras, T. J. DeGraba, P. B. Gorelick, J. R. Guyton, et al. Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline. Stroke, June 1, 2006; 37(6): 1583 - 1633. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C J Currie, M Jones, J Goodfellow, P McEwan, C L Morgan, C Emmas, and J R Peters Evaluation of survival and ischaemic and thromboembolic event rates in patients with non-valvar atrial fibrillation in the general population when treated and untreated with warfarin Heart, February 1, 2006; 92(2): 196 - 200. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Sato, K. Ishikawa, A. Kitabatake, S. Ogawa, Y. Maruyama, Y. Yokota, T. Fukuyama, Y. Doi, S. Mochizuki, T. Izumi, et al. Low-Dose Aspirin for Prevention of Stroke in Low-Risk Patients With Atrial Fibrillation: Japan Atrial Fibrillation Stroke Trial Stroke, February 1, 2006; 37(2): 447 - 451. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. G. Butchart, C. Gohlke-Barwolf, M. J. Antunes, P. Tornos, R. De Caterina, B. Cormier, B. Prendergast, B. Iung, H. Bjornstad, C. Leport, et al. Recommendations for the management of patients after heart valve surgery Eur. Heart J., November 2, 2005; 26(22): 2463 - 2471. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Rienstra, D. J. Van Veldhuisen, V. E. Hagens, A. V. Ranchor, N. J.G.M. Veeger, H. J.G.M. Crijns, I. C. Van Gelder, and for the RACE Investigators Gender-Related Differences in Rhythm Control Treatment in Persistent Atrial Fibrillation: Data of the Rate Control Versus Electrical Cardioversion (RACE) Study J. Am. Coll. Cardiol., October 4, 2005; 46(7): 1298 - 1306. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Arima, R. G. Hart, S. Colman, J. Chalmers, C. Anderson, A. Rodgers, M. Woodward, S. MacMahon, B. Neal, and for the PROGRESS Collaborative Group Perindopril-Based Blood Pressure-Lowering Reduces Major Vascular Events in Patients With Atrial Fibrillation and Prior Stroke or Transient Ischemic Attack Stroke, October 1, 2005; 36(10): 2164 - 2169. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Smith, L. D. Lisabeth, D. L. Brown, and L. B. Morgenstern Gender comparisons of diagnostic evaluation for ischemic stroke patients Neurology, September 27, 2005; 65(6): 855 - 858. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. C. Fang, D. E. Singer, Y. Chang, E. M. Hylek, L. E. Henault, N. G. Jensvold, and A. S. Go Gender Differences in the Risk of Ischemic Stroke and Peripheral Embolism in Atrial Fibrillation: The AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) Study Circulation, September 20, 2005; 112(12): 1687 - 1691. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. G. Sherman, S. G. Kim, B. S. Boop, S. D. Corley, J. P. DiMarco, R. G. Hart, L. J. Haywood, K. Hoyte, E. S. Kaufman, M. H. Kim, et al. Occurrence and Characteristics of Stroke Events in the Atrial Fibrillation Follow-up Investigation of Sinus Rhythm Management (AFFIRM) Study Arch Intern Med, May 23, 2005; 165(10): 1185 - 1191. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. O'Donnell, G. Agnelli, and J. I. Weitz Emerging therapies for stroke prevention in atrial fibrillation Eur. Heart J. Suppl., May 1, 2005; 7(suppl_C): C19 - C27. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. E Dager, T. G Vondracek, B. A McIntosh, and E. A Nutescu Ximelagatran: An Oral Direct Thrombin Inhibitor Ann. Pharmacother., November 1, 2004; 38(11): 1881 - 1897. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. F. Gage, C. van Walraven, L. Pearce, R. G. Hart, P. J. Koudstaal, B.S.P. Boode, and P. Petersen Selecting Patients With Atrial Fibrillation for Anticoagulation: Stroke Risk Stratification in Patients Taking Aspirin Circulation, October 19, 2004; 110(16): 2287 - 2292. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. E. Singer, G. W. Albers, J. E. Dalen, A. S. Go, J. L. Halperin, and W. J. Manning Antithrombotic Therapy in Atrial Fibrillation: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 429S - 456S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. E. Dager Ximelagatran: A New Antithrombotic Option in Atrial Fibrillation Journal of Cardiovascular Pharmacology and Therapeutics, July 1, 2004; 9(3): 151 - 162. [Abstract] [PDF]
|
|
|
|
|
|
E. Crystal and S. J Connolly Role of oral anticoagulation in management of atrial fibrillation Heart, July 1, 2004; 90(7): 813 - 817. [Full Text] [PDF]
|
|
|
|
|
|
S. G. Rockson and G. W. Albers Comparing the guidelines: anticoagulation therapy to optimize stroke prevention in patients with atrial fibrillation J. Am. Coll. Cardiol., March 17, 2004; 43(6): 929 - 935. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Kida Age and Sex as Independent Risk Factors for Stroke Among Patients With Atrial Fibrillation JAMA, December 10, 2003; 290(22): 2937 - 2937. [Full Text] [PDF]
|
|
|
|
|
|
T. J. Wang, J. M. Massaro, and E. J. Benjamin Age and Sex as Independent Risk Factors for Stroke Among Patients With Atrial Fibrillation--Reply JAMA, December 10, 2003; 290(22): 2937 - 2937. [Full Text] [PDF]
|
|
|
|
|
|
D. E. Singer A 60-Year-Old Woman With Atrial Fibrillation JAMA, October 22, 2003; 290(16): 2182 - 2189. [Full Text] [PDF]
|
|
|
|
|
|
J. L. Blackshear, W. D. Johnson, J. A. Odell, V. S. Baker, M. Howard, L. Pearce, C. Stone, D. L. Packer, and H. V. Schaff Thoracoscopic extracardiac obliteration of the left atrial appendage for stroke risk reduction in atrial fibrillation J. Am. Coll. Cardiol., October 1, 2003; 42(7): 1249 - 1252. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G.Q. Villani, M. Piepoli, P.E. Villani, and A. Capucci Anticoagulation in atrial fibrillation: what is certain and what is to come Eur. Heart J. Suppl., September 1, 2003; 5(suppl_H): H45 - H50. [Abstract] [PDF]
|
|
|
|
|
|
T. J. Wang, J. M. Massaro, D. Levy, R. S. Vasan, P. A. Wolf, R. B. D'Agostino, M. G. Larson, W. B. Kannel, and E. J. Benjamin A Risk Score for Predicting Stroke or Death in Individuals With New-Onset Atrial Fibrillation in the Community: The Framingham Heart Study JAMA, August 27, 2003; 290(8): 1049 - 1056. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Roldan, F. Marin, A. D Blann, A. Garcia, P. Marco, F. Sogorb, and G. Y.H Lip Interleukin-6, endothelial activation and thrombogenesis in chronic atrial fibrillation Eur. Heart J., July 2, 2003; 24(14): 1373 - 1380. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. G. Hart, L. A. Pearce, S. Di Legge, J. D. Spence, A. Tamayo, V. Hachinski, D. M. Green, A. H. Ropper, R. A. Kronmal, B. M. Psaty, et al. Serum potassium level and dietary potassium intake as risk factors for stroke Neurology, June 10, 2003; 60(11): 1869 - 1871. [Full Text] [PDF]
|
|
|
|
 |
|
 R. G. Hart, J. L. Halperin, L. A. Pearce, D. C. Anderson, R. A. Kronmal, R. McBride, E. Nasco, D. G. Sherman, R. L. Talbert, J. R. Marler, et al. Lessons from the Stroke Prevention in Atrial Fibrillation Trials Ann Intern Med, May 20, 2003; 138(10): 831 - 838. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. van Walraven, R. G. Hart, G. A. Wells, P. Petersen, P. J. Koudstaal, A. L. Gullov, B. S. P. Hellemons, B. G. Koefed, and A. Laupacis A Clinical Prediction Rule to Identify Patients With Atrial Fibrillation and a Low Risk for Stroke While Taking Aspirin Arch Intern Med, April 28, 2003; 163(8): 936 - 943. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. H Rutten, E. Hak, W. A. Stalman, T. J. Verheij, and A. W Hoes Is treatment of atrial fibrillation in primary care based on thromboembolic risk assessment? Fam. Pract., February 1, 2003; 20(1): 16 - 21. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S Illien, S Maroto-Jarvinen, G von der Recke, C Hammerstingl, H Schmidt, S Kuntz-Hehner, B Luderitz, and H Omran Atrial fibrillation: relation between clinical risk factors and transoesophageal echocardiographic risk factors for thromboembolism Heart, February 1, 2003; 89(2): 165 - 168. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. S.G. Conway, J. Heeringa, D. A.M. Van Der Kuip, B. S.P. Chin, A. Hofman, J. C.M. Witteman, and G. Y.H. Lip Atrial Fibrillation and the Prothrombotic State in the Elderly: The Rotterdam Study Stroke, February 1, 2003; 34(2): 413 - 417. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Radford, T. Church, F. E. Speizer, B. E. Pearson Murphy, S. R. Davis, H. G. Burger, W. H. Goodson III, H. R. Franke, I. Lev, A. Lahad, et al. Risks of Postmenopausal Hormone Replacement JAMA, December 11, 2002; 288(22): 2819 - 2824. [Full Text] [PDF]
|
|
|
|
 |
|
 I. C. Van Gelder, V. E. Hagens, H. A. Bosker, J. H. Kingma, O. Kamp, T. Kingma, S. A. Said, J. I. Darmanata, A. J.M. Timmermans, J. G.P. Tijssen, et al. A Comparison of Rate Control and Rhythm Control in Patients with Recurrent Persistent Atrial Fibrillation N. Engl. J. Med., December 5, 2002; 347(23): 1834 - 1840. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. Falk Management of Atrial Fibrillation -- Radical Reform or Modest Modification? N. Engl. J. Med., December 5, 2002; 347(23): 1883 - 1884. [Full Text] [PDF]
|
|
|
|
 |
|
 P. Khairy and S. Nattel New insights into the mechanisms and management of atrial fibrillation Can. Med. Assoc. J., October 29, 2002; 167(9): 1012 - 1020. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Mouradian, S. R. Majumdar, A. Senthilselvan, K. Khan, and A. Shuaib How Well Are Hypertension, Hyperlipidemia, Diabetes, and Smoking Managed After a Stroke or Transient Ischemic Attack? Stroke, June 1, 2002; 33(6): 1656 - 1659. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. G. Angeja, M. G. Shlipak, A. S. Go, S. C. Johnston, P. D. Frederick, J. G. Canto, H. V. Barron, D. Grady, and for the National Registry of Myocardial Infarction Hormone therapy and the risk of stroke after acute myocardial infarction in postmenopausal women J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1297 - 1301. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al. ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology Circulation, October 23, 2001; 104(17): 2118 - 2150. [Full Text] [PDF]
|
|
|
|
|
|
Guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology Eur. Heart J., October 2, 2001; 22(20): 1852 - 1923. [PDF]
|
|
|
|
|
|
A. J. Makin, D. S. G. Conway, G. Y. H. Lip, L. Frost, S. P. Johnsen, G. Engholm, E. Henneberg, and S. Husted Systemic Thromboembolism in Atrial Fibrillation Arch Intern Med, August 13, 2001; 161(15): 1920 - 1924. [Full Text] [PDF]
|
|
|
|
 |
|
 D S G CONWAY and G Y H LIP Anticoagulation and atrial fibrillation Postgrad. Med. J., July 1, 2001; 77(909): 487 - 487. [Full Text] [PDF]
|
|
|
|
|
|
B. F. Gage, A. D. Waterman, W. Shannon, M. Boechler, M. W. Rich, and M. J. Radford Validation of Clinical Classification Schemes for Predicting Stroke: Results From the National Registry of Atrial Fibrillation JAMA, June 13, 2001; 285(22): 2864 - 2870. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. G. Hart and J. L. Halperin Atrial Fibrillation and Stroke : Concepts and Controversies Stroke, March 1, 2001; 32(3): 803 - 808. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Simon, J. Hsia, J. A. Cauley, C. Richards, F. Harris, J. Fong, E. Barrett-Connor, and S. B. Hulley Postmenopausal Hormone Therapy and Risk of Stroke : The Heart and Estrogen-progestin Replacement Study (HERS) Circulation, February 6, 2001; 103(5): 638 - 642. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. W. Albers, J. E. Dalen, A. Laupacis, W. J. Manning, P. Petersen, and D. E. Singer Antithrombotic Therapy in Atrial Fibrillation Chest, January 1, 2001; 119 (2009): 194S - 206S. [Full Text] [PDF]
|
|
|
|
|
|
R. G. Hart Anticoagulation therapy for patients with atrial fibrillation Can. Med. Assoc. J., October 1, 2000; 163(8): 956 - 957. [Full Text] [PDF]
|
|
|
|
|
|
A. S. Go, E. M. Hylek, K. A. Phillips, L. H. Borowsky, L. E. Henault, Y. Chang, J. V. Selby, and D. E. Singer Implications of Stroke Risk Criteria on the Anticoagulation Decision in Nonvalvular Atrial Fibrillation : The Anticoagulation and Risk Factors In Atrial Fibrillation (ATRIA) Study Circulation, July 4, 2000; 102(1): 11 - 13. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Stern, D. Altkorn, and W. Levinson Anticoagulation for Chronic Atrial Fibrillation JAMA, June 14, 2000; 283(22): 2901 - 2903. [Full Text] [PDF]
|
|
|
|
|
|
S. MacMahon Blood Pressure and the Risk of Cardiovascular Disease N. Engl. J. Med., January 6, 2000; 342(1): 49 - 52. [Full Text]
|
|
|
|
|
|
R. G. Hart, L. A. Pearce, R. M. Rothbart, J. H. McAnulty, R. W. Asinger, J. L. Halperin, and for the Stroke Prevention in Atrial Fibrillation I Stroke with intermittent atrial fibrillation: incidence and predictors during aspirin therapy J. Am. Coll. Cardiol., January 1, 2000; 35(1): 183 - 187. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. M. Feinberg, L. A. Pearce, R. G. Hart, M. Cushman, E. S. Cornell, G. Y.H. Lip, and E. G. Bovill Markers of Thrombin and Platelet Activity in Patients With Atrial Fibrillation : Correlation With Stroke Among 1531 Participants in the Stroke Prevention in Atrial Fibrillation III Study Stroke, December 1, 1999; 30(12): 2547 - 2553. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. G. Hart and J. L. Halperin Atrial Fibrillation and Thromboembolism: A Decade of Progress in Stroke Prevention Ann Intern Med, November 2, 1999; 131(9): 688 - 695. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. G HART Warfarin in atrial fibrillation: underused in the elderly, often inappropriately used in the young Heart, November 1, 1999; 82(5): 539 - 540. [Full Text]
|
|
|
|
|
|
R. G. Hart, O. Benavente, R. McBride, and L. A. Pearce Antithrombotic Therapy To Prevent Stroke in Patients with Atrial Fibrillation: A Meta-Analysis Ann Intern Med, October 5, 1999; 131(7): 492 - 501. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Lichtman, H. M. Krumholz, Y. Wang, M. J. Radford, and L. M. Brass Risk and Predictors of Stroke After Myocardial Infarction Among the Elderly: Results From the Cooperative Cardiovascular Project Circulation, March 5, 2002; 105(9): 1082 - 1087. [Abstract] [Full Text] [PDF]
|
|