Annals On Call - Estimating Stroke Risk in Atrial Fibrillation
Authors: Robert M. Centor, Gustavo R. Heudebert
Journal: Annals of Internal Medicine (2019)

Web Exclusives19 February 2019Annals On Call - Estimating Stroke Risk in Atrial FibrillationFREERobert M. Centor, MD and Gustavo R. Heudebert, MDRobert M. Centor, MDHuntsville Regional Medical Campus, University of Alabama Birmingham School of Medicine, Birmingham, Alabama (R.M.C.)Search for more papers by this author and Gustavo R. Heudebert, MDUniversity of Alabama at Birmingham, Birmingham, Alabama (G.R.H.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/A18-0014 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this episode of Annals On Call, Dr. Centor discusses the estimation of stroke risk in patients with atrial fibrillation with Dr. Gustavo Heudebert, a professor of medicine at the University of Alabama.Annals articles discussed include...Effect of Variation in Published Stroke Rates on the Net Clinical Benefit of Anticoagulation for Atrial Fibrillation: https://annals.org/aim/fullarticle/2703439/effect-variation-published-stroke-rates-net-clinical-benefit-anticoagulation-atrialAbout Annals On CallAnnals On Call focuses on a clinically influential article published in Annals of Internal Medicine. Dr. Robert Centor shares his own perspective on the material and interviews topic area experts to discuss, debate, and share diverse insights about patient care and health care delivery.For more information on Annals On Call and for more episodes, visit go.annals.org/OnCall. Comments0 CommentsSign In to Submit A Comment Robert CentorUAB21 February 2019 Atrial fibrillation and sleep apena Thanks for your comment. I agree 100%. Burton AbramsNo institutional affiliation19 February 2019 Reducing Stroke Risk from Atrial Fibrillation Atrial fibrillation has been found to have much higher prevalence in the sleep apnea population relative to that in the general population – 5:1. Because of that high ratio, AF is the comorbidity of sleep apnea which is the strongest indicator of its presence [1]. Sleep apnea has also been shown to lead to hypercoagulabulity [2]. These two factors combine to significantly elevate the risk for ischemic stroke. Fortunately both factors may be reversible by overcoming the sleep apnea, even though it may take six months or longer for that to occur completely. During that period of time, the use of an anticoagulation drug may be indicated, but the blood would have to be frequently titred to appropriately reduce the drug dosage until finally discontinuing it.1. Abrams B. Hierarchy of comorbidity indicators for obstructive sleep apnea. Chest. 2010 Jun;137(6): 1491-2.2. Toraldo DM, De Benedetto M, Scoditti E, De Nuccio F. Obstructive sleep apnea syndrome: coagulation anomalies and treatment with continuous positive airway pressure. Sleep Breath. 2016 May;20(2): 457-65. Author, Article, and Disclosure InformationAffiliations: Huntsville Regional Medical Campus, University of Alabama Birmingham School of Medicine, Birmingham, Alabama (R.M.C.)University of Alabama at Birmingham, Birmingham, Alabama (G.R.H.)Disclosures: Dr. Centor has disclosed the following: Honoraria: Medscape. Dr. Heudebert has no interests or financial relationships to disclose.Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Proctor & Gamble, Pfizer, and Johnson & Johnson. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEffect of Variation in Published Stroke Rates on the Net Clinical Benefit of Anticoagulation for Atrial Fibrillation Sachin J. Shah , Mark H. Eckman , Sara Aspberg , Alan S. Go , and Daniel E. Singer Metrics 19 February 2019Volume 170, Issue 4Page: OC1KeywordsAtrial fibrillationDiagnostic techniquesDisclosureHealth carePatientsStroke ePublished: 19 February 2019 Issue Published: 19 February 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.Loading ...