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(Stroke. 2002;33:2150.)
© 2002 American Heart Association, Inc.

Letters to the Editor

Evaluation of Risk Factors for Stroke/Embolism and of Complications Due to Anticoagulant Therapy in Atrial Fibrillation

brahim yigün, MD

Departments of Neurology, Faculty of Medicine, Atatürk University, Erzurum, Turkey

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

In their article, Wehinger et al¹ examined the relationship between risk factors and complications in patients with atrial fibrillation (AF) and receiving oral anticoagulation (OAC) therapy. They reported that the complication rate in AF patients on OAC is higher in patients >65 years of age, patients with diabetes, those taking >3 additional drugs per day, and those with hypertension.

Before 1990, antithrombotic therapy for prevention of ischemic stroke and systemic embolism in patients with AF was limited mainly to those with rheumatic heart disease and prosthetic heart valves.² Anticoagulation was also accepted therapy for patients who had sustained ischemic stroke to prevent recurrence but was often delayed to avoid hemorrhagic transformation. Some advocated anticoagulation of patients with thyrotoxicosis or other conditions associated with cardiomyopathy and AF.³

OAC is effective in reducing stroke and embolism by 68% in patients with AF. OAC is particularly recommended if additional risk factors for stroke or embolism such as increased age, hypertension, diabetes, and previous stroke are present.⁴ However, other factors such as drug intake, drug interaction (especially nonsteroid anti-inflammatory drugs), or other problems influence this situation. In our clinical experiences, the hemorrhagic complication rate in AF patients on OAC associated with nonsteroid anti-inflammatory drugs was higher than in those with only OAC.

Nonrheumatic AF is the most common cause of embolism from the heart to the brain. However, AF may be responsible for a greater proportion of ischemic strokes in the very elderly.² In the European Atrial Fibrillation Trial,³ anticoagulants reduced the risk of . . . [Full Text of this Article]

Claudia Stöllberger, MD Cornelius Wehinger, MD

Second Medical Department, KA Rudolfstiftung, Vienna, Austria

Josef Finsterer, MD

Second Neurological Department, Hospital Rosenhügel, Vienna, Austria