Abstract
Atrial fibrillation (AF) is the most prevalent sustained heart arrhythmia. It is the most important clinical risk factor for systemic embolism (SE) and is regarded to be the cause of stroke in up to one fourth of cases [ [1] Grau A.J. Weimar C. Buggle F. Heinrich A. Goertler M. Neumaier S. Glahn J. Brandt T. Hacke W. Diener H.C. Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke. 2001; 32: 2559-2566 Crossref PubMed Scopus (730) Google Scholar ]. However, since stroke is much more prevalent than SE in patients with AF, the latter is not considered to be a main single outcome parameter in AF trials. As a consequence, the majority of trials on the role of anticoagulants in AF patients have focused over stroke prevention, and SE has been included only as a part of composite end-points. Thus, the superiority of warfarin compared to antiplatelet agents in preventing non-cerebral embolism has been proven only in a recent meta-analysis [ [2] Andersen L.V. Vestergaard P. Deichgraeber P. Lindholt J.S. Mortensen L.S. Frost L. Warfarin for the prevention of systemic embolism in patients with non-valvular atrial fibrillation: a meta-analysis. Heart. 2008; 94: 1607-1613 Crossref PubMed Scopus (60) Google Scholar ]. European and US guidelines currently recommend oral anticoagulants over antiplatelet agents for stroke prevention in AF, and these indications are thought to be applicable also for prevention of SE.
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