The American Journal of Medicine
Volume 123, Issue 6 , Pages 484-488 , June 2010

Improving Stroke Risk Stratification in Atrial Fibrillation

  • Gregory Y.H. Lip, MD

      Affiliations

    • University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, England
    • Corresponding Author InformationReprint requests should be addressed to Gregory Y. H. Lip, MD, University of Birmingham Centre for Cardiovascular Sciences City Hospital, Birmingham B18 7QH, United Kingdom
    • ,
  • Jonathan L. Halperin, MD

      Affiliations

    • The Cardiovascular Institute, Mount Sinai Medical Center, New York, New York

References 

  1. Stroke Risk in Atrial Fibrillation Working Group. Comparison of 12 risk stratification schemes to predict stroke in patients with nonvalvular atrial fibrillation. Stroke. 2008;39:1901–1910
  2. Hughes M, Lip GY Guideline Development Group, National Clinical Guideline for Management of Atrial Fibrillation in Primary and Secondary Care, National Institute for Health and Clinical Excellence. Stroke and thromboembolism in atrial fibrillation: a systematic review of stroke risk factors, risk stratification schema and cost effectiveness data. Thromb Haemost. 2008;99:295–304
  3. Goto S, Bhatt DL, Röther J, et al. REACH Registry Investigators Prevalence, clinical profile, and cardiovascular outcomes of atrial fibrillation patients with atherothrombosis. Am Heart J. 2008;156:855–863, 863.e2
  4. Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001;285:2864–2870
  5. National Collaborating Centre for Chronic Conditions. Atrial Fibrillation: National Clinical Guideline for Management in Primary and Secondary Care. London: Royal College of Physicians; 2006;
  6. Singer DE, Albers GW, Dalen JE, et al. American College of Chest Physicians Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl):546S–592S
  7. Fuster V, Ryden LE, Cannom DS, et al. Task Force on Practice Guidelines, American College of Cardiology/American Heart Association; Committee for Practice Guidelines, European Society of Cardiology; European Heart Rhythm Association; Heart Rhythm Society ACC/AHA/ESC 2006 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 (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation). Eur Heart J. 2006;27:1979–2030
  8. Lip GYH, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor based approach: The Euro Heart Survey on Atrial Fibrillation. Chest. 2010;137:263–272Epub 2009 Sep 17
  9. Davies M, Hobbs F, Davis R, et al. Prevalence of left-ventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England Screening study: a population based study. Lancet. 2001;358:439–444
  10. Atrial Fibrillation Investigators. Echocardiographic predictors of stroke in patients with atrial fibrillation: a prospective study of 1066 patients from 3 clinical trials. Arch Intern Med. 1998;17:357–364
  11. Lip GY, Frison L, Grind M SPORTIF Investigators. Effect of hypertension on anticoagulated patients with atrial fibrillation. Eur Heart J. 2007;28:752–759
  12. Singer DE, Chang Y, Fang MC, et al. The net clinical benefit of warfarin anticoagulation in atrial fibrillation (The ATRIA study). Ann Intern Med. 2009;151:297–305
  13. Rietbrock S, Heeley E, Plumb J, van Staa T. Chronic atrial fibrillation: incidence, prevalence, and prediction of stroke using the Congestive heart failure, Hypertension, Age >75, Diabetes mellitus, and prior Stroke or transient ischemic attack (CHADS2) risk stratification scheme. Am Heart J. 2008;156:57–64
  14. Lane DA, Lip GYH. Female gender is a risk factor for stroke and thromboembolism in atrial fibrillation patients. Thromb Haemostat. 2009;101:802–805
  15. Ezekowitz MD, Bridgers SL, James KE, et al. Warfarin in the prevention of stroke associated with nonrheumatic atrial fibrillation. N Engl J Med. 1992;327:1406–1412
  16. Stroke Prevention in Atrial Fibrillation Investigators, Committee on Echocardiography. Transesophageal echocardiographic correlates of thromboembolism in high-risk patients with atrial fibrillation. Ann Intern Med. 1998;128:639–647
  17. Poli D, Antonucci E, Grifoni E, et al. Stroke risk in atrial fibrillation patients on warfarin (Predictive ability of risk stratification schemes for primary and secondary prevention). Thromb Haemost. 2009;101:367–372
  18. Fang MC, Go AS, Chang Y, et al. ATRIA Study Group Comparison of risk stratification schemes to predict thromboembolism in people with nonvalvular atrial fibrillation. J Am Coll Cardiol. 2008;51:810–815
  19. Mant J, Hobbs R, Fletcher K, et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet. 2007;370:493–503
  20. Connolly S, Pogue J, Hart R, et al. ACTIVE Writing Group on behalf of the ACTIVE Investigators Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet. 2006;367:1903–1912
  21. The ACTIVE Investigators. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med. 2009 Apr 3;361:[Epub ahead of print]
  22. Connolly SJ, Ezekowitz MD, Yusuf S, et al. RE-LY Steering Committee and Investigators Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139–1151Epub 2009 Aug 30
  23. Sato H, Ishikawa K, Kitabatake A, et al. Japan Atrial Fibrillation Stroke Trial Group Low-dose aspirin for prevention of stroke in low-risk patients with atrial fibrillation: Japan Atrial Fibrillation Stroke Trial. Stroke. 2006;37:447–451

 Funding: None.

 Conflict of Interest: Dr Lip has received funding for research, consultancy, and lecturing from different manufacturers of drugs used for the treatment of atrial fibrillation, including AstraZeneca, Bayer, Boehringer Ingelheim, Astellas, Sanofi-Aventis, and Daichii-Sankyo. Dr Halperin has received consulting fees from Astellas Pharma, Bayer HealthCare, Biotronik, Boehringer Ingelheim, Daiichi Sankyo, Johnson & Johnson, and Sanofi-Aventis, and an honorarium from Portola Pharmaceuticals for data safety monitoring activities.

 Authorship: All authors had access to the data and played a role in writing this manuscript.

PII: S0002-9343(09)01151-6

doi: 10.1016/j.amjmed.2009.12.013

The American Journal of Medicine
Volume 123, Issue 6 , Pages 484-488 , June 2010

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