Abstract
Summary Currently, warfarin is the standard for stroke reduction inatrial fibrillation. Warfarin reduces the risk of systemicembolism and stroke in atrial fibrillation and is indicated aslong-term treatment for patients with atrial fibrillation andrisk factors for stroke, even when a rhythm control strategyis being used. Unless contraindications to anticoagulationdevelop, warfarin should not be stopped in these patients,even if atrial fibrillation is paroxysmal or if sinus rhythmappears to be maintained. Warfarin should be maintained attherapeutic levels (PT/INR 2.0–3.0) for best efficacy andsafety. Therapeutic PT/INRs 2.0 are particularly impor-tant at and prior to cardioversion attempts. Aspirin may beused in some low-risk patients with lone atrial fibrillation,no additional risk factors, and age 65 years.New therapies may revolutionize the approach to strokereduction in atrial fibrillation and include thrombin inhibi-tors and, in selected patients, left atrial occlusion tech-niques. However, safety and efficacy, particularly comparedto warfarin, need to be established prior to routine use ofthese treatments.
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