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Should we abandon the common practice of withholding oral anticoagulation in paroxysmal atrial fibrillation?

Nieuwlaat, Robby; Dinh, Trang; Olsson, Bertil LU ; Camm, A. John; Capucci, Alessandro; Tieleman, Robert G.; Lip, Gregory Y. H. and Crijns, Harry J. G. M. (2008) In European Heart Journal 29(7). p.915-922
Abstract
Aims To assess the relation between the atrial fibrillation (AF) subtype and thrombo-embolic events. Methods and results The observational Euro Heart Survey on AF (2003-04) enrolled 1509 paroxysmal, 1109 persistent, and 1515 permanent AF patients, according to the 2001 American College of Cardiology, American Heart Association, and the European Society of Cardiology guidelines definitions. A 1 year follow-up was performed. Permanent AF patients had at baseline a worse stroke risk profile than paroxysmal and persistent AF patients. In paroxysmal AF, the risk for stroke, any thrombo-embolism, major bleeding and the combined endpoint of cardiovascular mortality, any thrombo-embolism, and major bleeding was comparable with persistent and... (More)
Aims To assess the relation between the atrial fibrillation (AF) subtype and thrombo-embolic events. Methods and results The observational Euro Heart Survey on AF (2003-04) enrolled 1509 paroxysmal, 1109 persistent, and 1515 permanent AF patients, according to the 2001 American College of Cardiology, American Heart Association, and the European Society of Cardiology guidelines definitions. A 1 year follow-up was performed. Permanent AF patients had at baseline a worse stroke risk profile than paroxysmal and persistent AF patients. In paroxysmal AF, the risk for stroke, any thrombo-embolism, major bleeding and the combined endpoint of cardiovascular mortality, any thrombo-embolism, and major bleeding was comparable with persistent and permanent AF, in both univariable and multivariable analyses. Compared with AF patients without stroke, patients suffering from a stroke had a comparable frequency and duration of AF attacks, but tended to have a worse stroke risk profile at baseline. During 1 year following cardioversion, paroxysmal AF patients had a higher risk for stroke (P = 0.029) and any thrombo-embolism (P = 0.001) than persistent AF patients. Conclusion In the Euro Heart Survey, paroxysmal AF had a comparable risk for thrombo-embolic events as persistent and permanent AF. This observation strengthens the guideline recommendation not to consider the clinical AF subtype when deciding on anticoagulation. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
paroxysmal atrial fibrillation, stroke, anticoagulation, thrombo-embolism, atrial fibrillation, subtype
in
European Heart Journal
volume
29
issue
7
pages
915 - 922
publisher
Oxford University Press
external identifiers
  • wos:000254684900017
  • scopus:41849119802
ISSN
1522-9645
DOI
10.1093/eurheartj/ehn101
language
English
LU publication?
yes
id
97793058-b16a-4379-8bec-93040af16750 (old id 1208450)
date added to LUP
2008-08-27 09:08:09
date last changed
2017-10-01 04:27:03
@article{97793058-b16a-4379-8bec-93040af16750,
  abstract     = {Aims To assess the relation between the atrial fibrillation (AF) subtype and thrombo-embolic events. Methods and results The observational Euro Heart Survey on AF (2003-04) enrolled 1509 paroxysmal, 1109 persistent, and 1515 permanent AF patients, according to the 2001 American College of Cardiology, American Heart Association, and the European Society of Cardiology guidelines definitions. A 1 year follow-up was performed. Permanent AF patients had at baseline a worse stroke risk profile than paroxysmal and persistent AF patients. In paroxysmal AF, the risk for stroke, any thrombo-embolism, major bleeding and the combined endpoint of cardiovascular mortality, any thrombo-embolism, and major bleeding was comparable with persistent and permanent AF, in both univariable and multivariable analyses. Compared with AF patients without stroke, patients suffering from a stroke had a comparable frequency and duration of AF attacks, but tended to have a worse stroke risk profile at baseline. During 1 year following cardioversion, paroxysmal AF patients had a higher risk for stroke (P = 0.029) and any thrombo-embolism (P = 0.001) than persistent AF patients. Conclusion In the Euro Heart Survey, paroxysmal AF had a comparable risk for thrombo-embolic events as persistent and permanent AF. This observation strengthens the guideline recommendation not to consider the clinical AF subtype when deciding on anticoagulation.},
  author       = {Nieuwlaat, Robby and Dinh, Trang and Olsson, Bertil and Camm, A. John and Capucci, Alessandro and Tieleman, Robert G. and Lip, Gregory Y. H. and Crijns, Harry J. G. M.},
  issn         = {1522-9645},
  keyword      = {paroxysmal atrial fibrillation,stroke,anticoagulation,thrombo-embolism,atrial fibrillation,subtype},
  language     = {eng},
  number       = {7},
  pages        = {915--922},
  publisher    = {Oxford University Press},
  series       = {European Heart Journal},
  title        = {Should we abandon the common practice of withholding oral anticoagulation in paroxysmal atrial fibrillation?},
  url          = {http://dx.doi.org/10.1093/eurheartj/ehn101},
  volume       = {29},
  year         = {2008},
}