Female sex was inconsistently associated with stroke risk , whereas the evidence was inconclusive that either heart failure or coronary artery disease is independently predictive of stroke .
Conclusions : Four clinical features ( prior stroke/TIA , advancing age , hypertension , diabetes ) are consistent independent risk factors for stroke in atrial fibrillation patients .
Background : Absolute stroke rates vary widely among patients with nonvalvular atrial fibrillation .
To balance the benefits and risks of chronic antithrombotic prophylaxis , it is important to estimate the absolute risk of stroke for individual patients .
Should Stroke Subtype Influence Anticoagulation Decisions to Prevent Recurrence in Stroke Patients With Atrial Fibrillation?
Background and Purpose — Long-term anticoagulation is routinely used for secondary stroke prevention in atrial fibrillation , often regardless of stroke subtype . Although the role of warfarin in cardioembolic stroke is established , it may not prevent recurrence in other stroke subtypes , even in the presence of atrial fibrillation . Methods — This was a 2-year , prospect i ve , intervention study conducted in a district general hospital . Participants included 386 acute stroke patients with atrial fibrillation . Subjects were characterized for stroke subtype on clinical , neuroimaging , carotid ultrasonographic , and echocardiographic criteria . Eligible patients were treated with adjusted-dose warfarin ( international normalized ratio , 2.0 to 3.0 ) . Aspirin ( 75 to 300 mg/d ) was used in patients with contraindications or those who refused anticoagulation . The main outcome measures were rate of recurrent stroke by subtype and major and minor bleeding complications . Results — The  aspirin group ( n=172 ) was comparable to the  warfarin group ( n=214 ) in terms of age , sex , risk factors , and initial stroke subtype . The rate of recurrent stroke was higher ( 9.5 % versus 4.9 % , P < 0.02 ) but that of major bleeding was lower ( 0.6 % versus 2.5 % , P < 0.05 ) with aspirin . The increased stroke rate with aspirin was due predominantly to cardioembolic recurrence in patients presenting initially with cardioembolic stroke ( 8.4 % versus 1.9 % , P < 0.01 ) . The recurrence rate in aspirin-treated patients who presented with lacunar stroke and atrial fibrillation was similar to that seen in patients receiving warfarin ( 8.8 % versus 8.9 % ) . Conclusions — In this cohort of stroke patients with atrial fibrillation , anticoagulation was superior to aspirin in preventing cardioembolic but not lacunar recurrence . Determination of stroke subtype may be important in anticoagulation decisions for secondary prevention , and further studies are required
Female sex was inconsistently associated with stroke risk , whereas the evidence was inconclusive that either heart failure or coronary artery disease is independently predictive of stroke .
Conclusions : Four clinical features ( prior stroke/TIA , advancing age , hypertension , diabetes ) are consistent independent risk factors for stroke in atrial fibrillation patients .
Background : Absolute stroke rates vary widely among patients with nonvalvular atrial fibrillation .
To balance the benefits and risks of chronic antithrombotic prophylaxis , it is important to estimate the absolute risk of stroke for individual patients .