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(Stroke. 2007;38:614.)
© 2007 American Heart Association, Inc.

Novel Approaches to Stroke Prevention in Atrial Fibrillation: Introduction

Novel Approaches to Stroke Prevention in Atrial Fibrillation

Introduction

Thomas G. Brott, MD

From the Department of Neurology, Mayo Clinic, Jacksonville, Fla.

Correspondence to Thomas G. Brott, MD, Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224. E-mail brott.thomas@mayo.edu

Key Words: atrial fibrillation • stroke • warfarin

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

Both the incidence and prevalence of atrial fibrillation increase with advancing age. Hence, the burden posed by stroke resulting from atrial fibrillation will continue to increase. Varying pharmacological methods to prevent such strokes have been tested over the preceding decades. Warfarin, warfarin plus dipyridamole, aspirin, warfarin plus aspirin, low-dose warfarin, and other regimens have been evaluated in clinical trials. The most rigorous trials have shown conventional dose warfarin, by itself, to be the most effective and safe means of stroke prevention for patients with heart disease and atrial fibrillation. New agents are in development or under evaluation in randomized clinical trials, but for now warfarin is the gold standard in clinical practice.

Yet treatment with warfarin carries its own burdens, the most severe being warfarin-related intracranial hemorrhage (ICH). Dose-effect for efficacy has been identified in clinical trials, and so adequate doses of warfarin are required to prevent stroke. Dose-effect for warfarin-related ICH is supported by case series, and so ICH is more likely to occur if doses are too high. Careful hematologic monitoring of patient-coagulation status is of paramount importance but has been difficult to achieve consistently. The elderly are at greater risk for warfarin-related ICH, but decreasing mobility, decreasing access to easy transportation, and decreasing financial capacity make compliance and adequate monitoring an unreachable goal. As a result, warfarin-related ICH is a familiar therapeutic challenge for all neurologists and neurosurgeons wherever warfarin is used.

Safe alternatives to warfarin must be developed. Warfarin-related ICH is more deadly than subarachnoid hemorrhage . . . [Full Text of this Article]