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Anticoagulation in patients at high risk of stroke without documented atrial fibrillation. Time for a paradigm shift?

Bayés de Luna, Antoni; Baranchuk, Adrian; Martínez-Sellés, Manuel and Platonov, Pyotr G. LU (2017) In Annals of Noninvasive Electrocardiology 22(1).
Abstract

Atrial fibrillation (AF) is currently considered a risk factor for stroke. Depending on the severity of clinical factors (risk scores) a recommendation for full anticoagulation is made. Although AF is most certainly a risk factor for ischemic stroke, it is not necessarily the direct cause of it. The causality of association between AF and ischemic stroke is questioned by the reported lack of temporal relation between stroke events and AF paroxysms (or atrial high-rate episodes detected by devices). In different studies, only 2% of patients had subclinical AF > 6 minutes in duration at the time of stroke or systemic embolism. Is it time to consider AF only one more factor of endothelial disarray rather than the main contributor to... (More)

Atrial fibrillation (AF) is currently considered a risk factor for stroke. Depending on the severity of clinical factors (risk scores) a recommendation for full anticoagulation is made. Although AF is most certainly a risk factor for ischemic stroke, it is not necessarily the direct cause of it. The causality of association between AF and ischemic stroke is questioned by the reported lack of temporal relation between stroke events and AF paroxysms (or atrial high-rate episodes detected by devices). In different studies, only 2% of patients had subclinical AF > 6 minutes in duration at the time of stroke or systemic embolism. Is it time to consider AF only one more factor of endothelial disarray rather than the main contributor to stroke? In this “opinion paper” we propose to consider not only clinical variables predicting AF/stroke but also electrocardiographic markers of atrial fibrosis, as we postulate this as a strong indicator of risk of AF/stroke. We ask if it is time to change the paradigm and to consider, in some special situations, to protect patients (preventing stroke) who have no evidence of AF.

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author
organization
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type
Contribution to journal
publication status
published
subject
in
Annals of Noninvasive Electrocardiology
volume
22
issue
1
publisher
Wiley-Blackwell
external identifiers
  • wos:000399309900015
  • scopus:85014112104
ISSN
1082-720X
DOI
10.1111/anec.12417
language
English
LU publication?
yes
id
683ceef4-b988-4e92-b3b8-6c6b370cff75
date added to LUP
2017-01-19 14:31:16
date last changed
2018-10-03 10:10:52
@article{683ceef4-b988-4e92-b3b8-6c6b370cff75,
  abstract     = {<p>Atrial fibrillation (AF) is currently considered a risk factor for stroke. Depending on the severity of clinical factors (risk scores) a recommendation for full anticoagulation is made. Although AF is most certainly a risk factor for ischemic stroke, it is not necessarily the direct cause of it. The causality of association between AF and ischemic stroke is questioned by the reported lack of temporal relation between stroke events and AF paroxysms (or atrial high-rate episodes detected by devices). In different studies, only 2% of patients had subclinical AF &gt; 6 minutes in duration at the time of stroke or systemic embolism. Is it time to consider AF only one more factor of endothelial disarray rather than the main contributor to stroke? In this “opinion paper” we propose to consider not only clinical variables predicting AF/stroke but also electrocardiographic markers of atrial fibrosis, as we postulate this as a strong indicator of risk of AF/stroke. We ask if it is time to change the paradigm and to consider, in some special situations, to protect patients (preventing stroke) who have no evidence of AF.</p>},
  articleno    = {e12417},
  author       = {Bayés de Luna, Antoni and Baranchuk, Adrian and Martínez-Sellés, Manuel and Platonov, Pyotr G.},
  issn         = {1082-720X},
  language     = {eng},
  month        = {01},
  number       = {1},
  publisher    = {Wiley-Blackwell},
  series       = {Annals of Noninvasive Electrocardiology},
  title        = {Anticoagulation in patients at high risk of stroke without documented atrial fibrillation. Time for a paradigm shift?},
  url          = {http://dx.doi.org/10.1111/anec.12417},
  volume       = {22},
  year         = {2017},
}