193 - Management of Atrial Fibrillation

Abstract

This chapter discusses the management of atrial fibrillation (AF) in patients. About 16% of all ischemic strokes occur in patients with nonvalvular AF, with the frequency increasing directly with the mean age of the stroke population. Stroke due to AF is a frequent cause of disabling strokes in the elderly, particularly in elderly women. Most ischemic strokes in patients with AF are due to embolism of thrombi forming in the left atrium and particularly its appendage. Based on clinical studies, about 70% of ischemic strokes in AF patients are presumed to be cardioembolic. Chronic hypertension, present in about half of AF patients, increases the risk for both cardioembolic and noncardioembolic ischemic strokes in AF patients. For management, warfarin is highly efficacious for preventing stroke in AF patients and appears to be relatively safe for selected patients. Aspirin offers substantially less benefit, possibly by decreasing more minor, noncardioembolic strokes. The key to selection of antithrombotic prophylaxis is risk stratification. Most people with nonvalvular AF will not experience stroke even if untreated; blanket recommendations to treat all people with AF with life-long warfarin are not ideal.