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Robby Nieuwlaat, Trang Dinh, S. Bertil Olsson, A. John Camm, Alessandro Capucci, Robert G. Tieleman, Gregory Y.H. Lip, Harry J.G.M. Crijns, on behalf of the Euro Heart Survey Investigators, Should we abandon the common practice of withholding oral anticoagulation in paroxysmal atrial fibrillation?, European Heart Journal, Volume 29, Issue 7, April 2008, Pages 915–922, https://doi.org/10.1093/eurheartj/ehn101
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Abstract
To assess the relation between the atrial fibrillation (AF) subtype and thrombo-embolic events.
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.
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.
- anticoagulation
- atrial fibrillation
- electric countershock
- hemorrhage
- cerebrovascular accident
- ischemic stroke
- american heart association
- follow-up
- guidelines
- heart
- persistence
- paroxysmal atrial fibrillation
- embolism
- stroke risk
- cardiovascular death
- american college of cardiology
- permanent atrial fibrillation
- persistent atrial fibrillation
- european society of cardiology