Journal of cardiovascular medicine
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J Cardiovasc Med (Hagerstown) · Feb 2012
ReviewCost-effectiveness of pharmacologic and invasive therapies for stroke prophylaxis in atrial fibrillation.
Atrial fibrillation is an abnormal heart rhythm characterized by rapid, disorganized activation (fibrillation) of the left and right atria of the heart, and is responsible for 15% of 700,000 strokes in the United States each year. There are multiple pharmacologic and nonpharmacologic therapies used for stroke prevention in atrial fibrillation, including vitamin K antagonists such as warfarin, antiplatelet agents such as aspirin and clopidogrel, and newer agents such as dabigatran, rivaroxaban and apixaban. ⋯ In this article, we review the principles of CEA and identify 11 articles that examine CEA of stroke prophylaxis strategies in atrial fibrillation. Although most studies evaluate aspirin and warfarin across a variety of atrial fibrillation stroke risk profiles, we also review new literature on new pharmacologic therapies such as direct thrombin inhibitors and discuss the potential value of device-based therapies.
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Atrial fibrillation (AF) is a common arrhythmia associated with substantial morbidity and mortality, particularly due to thromboembolic strokes, the prevalence of which is expected to rise over the next few decades. This article reviews the complex mechanisms behind thromboembolism, compares the newer risk stratification models for identifying those at risk for stroke or bleeding, and highlights the potential advantages and disadvantages of available therapies. ⋯ There is also discussion on non pharmacological therapies such as left atrial appendage ligation and occlusion devices. This article is intended to help clinicians gain a better understanding of available risk stratification tools and therapies available for prevention of stroke in patients with atrial fibrillation.