Intensity of Anticoagulation To Prevent Stroke in Patients with Atrial Fibrillation
Authors: Robert G. Hart
Journal: Annals of Internal Medicine (1998)

Letters1 March 1998Intensity of Anticoagulation To Prevent Stroke in Patients with Atrial FibrillationRobert G. Hart, MDRobert G. Hart, MDUniversity of Texas Health Science Center; San Antonio, TX 78284Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-128-5-199803010-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In their "Update in General Internal Medicine," Sheffield and Larson [1] cite the conclusions of a case–control study [2] reporting that the lowest effective intensity of warfarin for atrial fibrillation is an international normalized ratio (INR) of 2.0. This is an oversimplification of available information.In the case–control study by Hylek and colleagues [2], INRs of 2.0 or more seemed to provide optimal protection against stroke. However, INRs between 1.6 and 1.9 were associated with an 80% or greater reduction in risk for stroke compared with INRs of 1.0 to 1.1 (equivalent to untreated patients). This partial ...References1. Sheffield JV, Larson EB. Update in general internal medicine. Ann Intern Med. 1997; 127:43-51. Google Scholar2. Hylek EM, Skates SJ, Sheehan MA, Singer DE. An analysis of the lowest effective intensity of prophylactic anticoagulation for patients with nonrheumatic atrial fibrillation. N Engl J Med. 1996; 335:540-6. Google Scholar3. Adjusted-dose warfarin versus low-intensity, fixed-dose warfarin plus aspirin for high-risk patients with atrial fibrillation: stroke prevention in atrial fibrillation III randomized clinical trial. Stroke Prevention in Atrial Fibrillation Investigators. Lancet. 1996; 348:633-8. Google Scholar4. Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. Veterans Affairs Stroke Prevention in Nonrheumatic Atrial Fibrillation Investigators. N Engl J Med. 1992; 327:1406-12. Google Scholar5. The effect of low-dose warfarin on the risk of stroke in non-rheumatic atrial fibrillation. Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. N Engl J Med. 1990; 323:1505-11. Google Scholar Author, Article, and Disclosure InformationAuthors: Robert G. Hart, MDAffiliations: University of Texas Health Science Center; San Antonio, TX 78284 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byIndonesian registry on atrial fibrillation (OneAF)Evidence-Based Management of Anticoagulant TherapyVascular DementiaHeart Disease and Stroke Statistics—2011 UpdateSecondary Prevention of Cardioembolic StrokeHeart Disease and Stroke Statistics—2010 UpdateHeart Disease and Stroke Statistics—2009 UpdateRisk Factor Management to Prevent First StrokeMeta-analysis: Antithrombotic Therapy to Prevent Stroke in Patients Who Have Nonvalvular Atrial FibrillationRobert G. Hart, MD, Lesly A. Pearce, MS, and Maria I. Aguilar, MDPrimary Prevention of Ischemic StrokeAtrial fibrillation and stroke: Four treatment controversiesAntiplatelet therapy for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacksPeople Aged Over 75 in Atrial Fibrillation on Warfarin: The Rate of Major Hemorrhage and Stroke in More Than 500 Patient-Years of Follow-UpSecondary Prevention of Cardioembolic StrokeAtrial Fibrillation in the Elderly: Anticoagulation Strategies and Indications in the Very ElderlyNeurologic Manifestations of Cardiogenic EmbolismACC/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 ElectrophysiologyACC/AHA/ESC guidelines for the management of patients with atrial fibrillation31This document was approved by the American College of Cardiology Board of Trustees in August 2001, the American Heart Association Science Advisory and Coordinating Committee in August 2001, and the European Society of Cardiology Board and Committee for Practice Guidelines and Policy Conferences in August 2001.32When citing this document, the American College of Cardiology, the American Heart Association, and the European Society of Cardiology would appreciate the following citation format: Fuster V, Rydén LE, Asinger RW, Cannom DS, Crijns HJ, Frye RL, Halperin JL, Kay GN, Klein WW, Lévy S, McNamara RL, Prystowsky EN, Wann LS, Wyse DG. ACC/AHA/ESC 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). J Am Coll Cardiol 2001;38:XX-XX.33This document is available on the World Wide Web sites of the American College of Cardiology (www.acc.org), the American Heart Association (www.americanheart.org), the European Society of Cardiology (www.escardio.org), and the North American Society of Pacing and Electrophysiology (www.naspe.org). Single reprints of this document (the complete Guidelines) to be published in the mid-October issue of the European Heart Journal are available by calling +44.207.424.4200 or +44.207.424.4389, faxing +44.207.424.4433, or writing Harcourt Publishers Ltd, European Heart Journal, ESC Guidelines – Reprints, 32 Jamestown Road, London, NW1 7BY, United Kingdom. Single reprints of the shorter version (Executive Summary and Summary of Recommendations) published in the October issue of the Journal of the American College of Cardiology and the October issue of Circulation, are available for $5.00 each by calling 800-253-4636 (US only) or by writing the Resource Center, American College of Cardiology, 9111 Old Georgetown Road, Bethesda, Maryland 20814. To purchase bulk reprints specify version and reprint number (Executive Summary 71-0208; full text 71-0209) up to 999 copies, call 800-611-6083 (US only) or fax 413-665-2671; 1000 or more copies, call 214-706-1466, fax 214-691-6342; or E-mail: [email protected].ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summaryAnticoagulation in the elderlyWarfarin Therapy for an Octogenarian Who Has Atrial FibrillationBrian F. Gage, MD, MSc, Stephan D. Fihn, MD, MPH, and Richard H. White, MDAtrial Fibrillation and StrokeThe Sin of Omission: A Systematic Review of Antithrombotic Therapy to Prevent Stroke in Atrial FibrillationAntithrombotic Therapy in Atrial FibrillationSecondary Prevention of Stroke in Patients with Nonvalvular Atrial FibrillationUse of Oral Anticoagulants in Older PatientsStroke with intermittent atrial fibrillation: incidence and predictors during aspirin therapyAtrial Fibrillation and Thromboembolism: A Decade of Progress in Stroke PreventionRobert G. Hart, MD and Jonathan L. Halperin, MDAntithrombotic Therapy To Prevent Stroke in Patients with Atrial Fibrillation A Meta-AnalysisRobert G. Hart, MD, Oscar Benavente, MD, Ruth McBride, BS, and Lesly A. Pearce, MSFactors Associated With Ischemic Stroke During Aspirin Therapy in Atrial FibrillationAntithrombotic Therapy in Atrial Fibrillation 1 March 1998Volume 128, Issue 5Page: 408KeywordsAtrial fibrillationClinical trial reportingElderlyHemorrhageInternational normalized ratioProthrombin timeRandomized trialsStroke ePublished: 15 August 2000 Issue Published: 1 March 1998 Copyright & PermissionsCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...