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Flaker G, Weachter R. Pharmacologic strategies for the prevention of stroke in patients with atrial fibrillation. Curr Treat Options Cardiovasc Med. 2011;13(5):361-9doi: 10.1007/s11936-011-0139-4.
Flaker, G., & Weachter, R. (2011). Pharmacologic strategies for the prevention of stroke in patients with atrial fibrillation. Current treatment options in cardiovascular medicine, 13(5), 361-9. https://doi.org/10.1007/s11936-011-0139-4
Flaker, Greg, and Weachter, Richard. "Pharmacologic strategies for the prevention of stroke in patients with atrial fibrillation." Current treatment options in cardiovascular medicine vol. 13,5 (2011): 361-9. doi: https://doi.org/10.1007/s11936-011-0139-4
Flaker G, Weachter R. Pharmacologic strategies for the prevention of stroke in patients with atrial fibrillation. Curr Treat Options Cardiovasc Med. 2011 Oct;13(5):361-9. doi: 10.1007/s11936-011-0139-4. PMID: 21732039.
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Curr Treat Options Cardiovasc Med. 2011 Oct;13(5):361-9. doi: 10.1007/s11936-011-0139-4.

Pharmacologic strategies for the prevention of stroke in patients with atrial fibrillation.

Current treatment options in cardiovascular medicine

Greg Flaker, Richard Weachter

Affiliations

  1. Division of Cardiovascular Medicine, University of Missouri-Columbia, Five Hospital Drive, CE306, Columbia, MO, 65212, USA, [email protected].

PMID: 21732039 DOI: 10.1007/s11936-011-0139-4

Abstract

OPINION STATEMENT: Stroke is a dreaded complication of atrial fibrillation. In the past, preventive therapy included aspirin and oral anticoagulation. Selected patients who are not suitable for oral anticoagulation may benefit from the addition of clopidogrel with aspirin. This combination, when compared with aspirin, offers a reduced risk of stroke at a cost of more major bleeding. We use this therapy in patients with atrial fibrillation who have unstable coronary syndromes or in patients who receive coronary artery stents who are not good candidates for "triple therapy" with aspirin, clopidogrel, and warfarin. The duration of therapy is tempered by many variables. In the case of coronary stents, we ask the interventionalist to consider a bare metal stent to shorten the duration of need for clopidogrel plus aspirin. After several months of combination therapy, we stop this therapy and begin warfarin therapy. Dabigatran is commercially available in the United States. In patients who have difficult to control International Normalized Ratio (INR) values or who do not wish to have regular coagulation monitoring, dabigatran offers a huge advantage. The benefit seems less if the INR is consistently within range. We are impressed with the superior reduction in stroke and systemic embolism with 150 mg of dabigatran twice daily compared to warfarin and also its low risk of intracranial hemorrhage. The results of clinical trials involving factor Xa agents are now being presented. How these agents fit into the marketplace remains to be seen but they will offer clinicians additional therapy for stroke prevention in atrial fibrillation.

References

  1. J Am Coll Cardiol. 2011 Jan 11;57(2):223-42 - PubMed
  2. Br J Clin Pharmacol. 2007 Sep;64(3):292-303 - PubMed
  3. Stroke. 1999 Dec;30(12):2547-53 - PubMed
  4. Ann Intern Med. 2007 Jun 19;146(12):857-67 - PubMed
  5. Chest. 1992 Oct;102(4 Suppl):426S-433S - PubMed
  6. Am J Cardiol. 2001 Jan 15;87(2):168-71 - PubMed
  7. J Thromb Haemost. 2007 Nov;5(11):2178-85 - PubMed
  8. JAMA. 2005 Feb 9;293(6):681-9 - PubMed
  9. Eur Heart J. 2002 Nov;23(22):1788-95 - PubMed
  10. Lancet. 2008 Jan 26;371(9609):315-21 - PubMed
  11. Br Heart J. 1995 Jun;73(6):527-33 - PubMed
  12. J Am Coll Cardiol. 2002 Aug 7;40(3):484-90 - PubMed
  13. Blood Coagul Fibrinolysis. 1992 Aug;3(4):469-73 - PubMed
  14. J Am Coll Cardiol. 1990 Aug;16(2):377-80 - PubMed
  15. Ann Intern Med. 2011 Jan 4;154(1):1-11 - PubMed
  16. Lancet. 2010 Sep 18;376(9745):975-83 - PubMed
  17. Lancet. 2007 Sep 15;370(9591):949-56 - PubMed
  18. Lancet. 2003 Nov 22;362(9397):1691-8 - PubMed
  19. Lancet. 2006 Jun 10;367(9526):1903-12 - PubMed
  20. Lancet. 2002 Jan 26;359(9303):294-302 - PubMed
  21. N Engl J Med. 2009 May 14;360(20):2066-78 - PubMed
  22. JAMA. 2005 Feb 9;293(6):690-8 - PubMed
  23. N Engl J Med. 2003 Oct 30;349(18):1713-21 - PubMed
  24. Am Heart J. 2010 Mar;159(3):340-347.e1 - PubMed
  25. Lancet. 2003 Sep 6;362(9386):789-97 - PubMed
  26. Stroke. 1990 Jan;21(1):47-51 - PubMed
  27. J Arthroplasty. 2009 Jan;24(1):1-9 - PubMed
  28. J Am Coll Cardiol. 2010 May 18;55(20):2225-31 - PubMed
  29. N Engl J Med. 2009 Sep 17;361(12):1139-51 - PubMed
  30. Circulation. 1996 Aug 1;94(3):425-31 - PubMed
  31. J Thromb Haemost. 2006 Sep;4(9):1944-9 - PubMed

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