0
January 1986, Vol 43, No. 1 >
Article | January 1986

The Secondary Prevention of Stroke in Patients With Atrial Fibrillation

David G. Sherman, MD; Robert G. Hart, MD; J. Donald Easton, MD
[+] Author Affiliations

Accepted for publication Nov 8, 1984.

Reprint requests to Division of Neurology, Department of Medicine, University of Texas Health Science Center, San Antonio, TX 78284 (Dr Sherman).


Arch Neurol. 1986;43(1):68-70. doi:10.1001/archneur.1986.00520010062024
Text Size: A A A
Published online
Article
References
Comments

Ischemic stroke in patients with nonrheumatic atrial fibrillation (AF) is common. No one knows how optimally to prevent its recurrence.

About 15% of all ischemic strokes occur in patients with AF.13 Conversely, about 35% of patients with AF will experience ischemic stroke during their lifetime.4-6 In patients with AF who have experienced an initial stroke, 20% or more will experience recurrent brain infarction within one year (Table 1). Hence, the dilemma of secondary-stroke prevention in patients with AF is a common one.

Not all ischemic strokes in patients with AF are caused by cardiogenic embolism, since cerebrovascular atherosclerosis often coexists in elderly patients with AF. The fraction of these strokes due to cardiogenic embolism is uncertain, as clinical and even autopsy data are discrepant (Table 2). All causes of nonrheumatic AF seem to share a similar embolic potential, with the common denominator of stasis within the left atrium

REFERENCES

1 +
Wolf PA, Dawber TR, Thomas HE, et al:  Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: The Framingham Study . Neurology 1978;;28:973-977.
2 +
Norris JW, Froggatt GM, Hachinski VC:  Cardiac arrhythmias in acute stroke . Stroke 1978;; 9:392-396.
3 +
Greenland P, Knopman DS, Mikell FL, et al:  Echocardiography in diagnostic assessment of stroke . Ann Intern Med 1981;;95:51-53.
4 +
Fisher CM:  Reducing risks of cerebral embolism . Geriatrics 1979;;34:59-66.
5 +
Sherman DG, Goldman L, Whiting RB, et al:  Risk of thromboembolism in patients with atrial fibrillation . Arch Neurol 1984;;41:708-710.
6 +
Hinton RC, Kistler JP, Fallon JT, et al:  Influence of etiology of atrial fibrillation on incidence of systemic embolism . Am J Cardiol 1977;;40:509-513.
7 +
Sage JI, VanUitert RL:  Risk of recurrent stroke with atrial fibrillation: Differences between rheumatic and arteriosclerotic heart disease . Stroke 1983;;14:537-540.
8 +
Wolf PA, Kannel WB, McGee DL, et al:  Duration of atrial fibrillation and imminence of stroke: The Framingham Study . Stroke 1983;; 14:664-667.
9 +
Darling RC, Austin WG, Linton RR:  Arterial embolism . Surg Gynecol Obstet 1967;;124:106-114.
10 +
Hart RG, Coull BM, Hart D:  Early recurrent embolism associated with nonvalvular atrial fibrillation: A retrospective study . Stroke 1983;;14:688-693.
11 +
Britton M, Gustafsson C:  Nonrheumatic atrial fibrillation as a risk factor for stroke . Stroke 1985;;16:182-188.
12 +
Mohr JP, Caplan LR, Melski JW, et al:  The Harvard Cooperative Stroke Registry: A prospective registry . Neurology 1978;;28:754-762.
13 +
Jorgensen L, Torvik A:  Ischemie cerebrovascular diseases in an autopsy series: Part I . J Neurol Sci 1966;;3:490-509.
14 +
Bar-Sela S, Ehrenfeld M, Eliakim M:  Arterial embolism in thyrotoxicosis with atrial fibrillation . Arch Intern Med 1981;;141:1191-1192.
15 +
Close JB, Evans DW, Bailey SM:  Persistent lone atrial fibrillation: Its prognosis after clinical diagnosis . J R Coll Gen Pract 1979;;29:547-549.
16 +
Harrison MJG, Marshall J:  Atrial fibrillation, TIAs and completed strokes . Stroke 1984;; 15:441-442.
17 +
Forfar JC:  Prediction of hemorrhage during long-term oral coumarin anticoagulation . Am Heart J 1982;;103:445-447.
18 +
Whisnant JP, Cartlidge NE, Elveback LR:  Carotid and vertebral-basilar TIA: Effect of anticoagulants, hypertension and cardiac disorders on survival and stroke occurrence . Ann Neurol 1978;;3:107-115.
19 +
Nunez L, Aguado MG, Larrea JL, et al:  Prevention of thromboembolism using aspirin after mitral valve replacement with porcine bioprosthesis . Ann Thorac Surg 1984;;37:84-87.
20 +
Kelley RE, Berger JR, Alter M, et al:  Cerebral ischemia and atrial fibrillation . Neurology 1985;;35:938-939.
21 +
Santamaria J, Graus F, Peres J:  Cerebral embolism and anticoagulation . Neurology 1983;; 33:1104.
22 +
Cerebral Embolism Study Group:  Immediate anticoagulation of embolic stroke: Brain hemorrhage and management options . Stroke 1984;;779-789.
23 +
Cerebral Embolism Study Group:  Immediate anticoagulation of embolic stroke: A randomized trial . Stroke 1983;;14:668-676.

First Page Preview

First page PDF preview

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Wolf PA, Dawber TR, Thomas HE, et al:  Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: The Framingham Study . Neurology 1978;;28:973-977.
2 +
Norris JW, Froggatt GM, Hachinski VC:  Cardiac arrhythmias in acute stroke . Stroke 1978;; 9:392-396.
3 +
Greenland P, Knopman DS, Mikell FL, et al:  Echocardiography in diagnostic assessment of stroke . Ann Intern Med 1981;;95:51-53.
4 +
Fisher CM:  Reducing risks of cerebral embolism . Geriatrics 1979;;34:59-66.
5 +
Sherman DG, Goldman L, Whiting RB, et al:  Risk of thromboembolism in patients with atrial fibrillation . Arch Neurol 1984;;41:708-710.
6 +
Hinton RC, Kistler JP, Fallon JT, et al:  Influence of etiology of atrial fibrillation on incidence of systemic embolism . Am J Cardiol 1977;;40:509-513.
7 +
Sage JI, VanUitert RL:  Risk of recurrent stroke with atrial fibrillation: Differences between rheumatic and arteriosclerotic heart disease . Stroke 1983;;14:537-540.
8 +
Wolf PA, Kannel WB, McGee DL, et al:  Duration of atrial fibrillation and imminence of stroke: The Framingham Study . Stroke 1983;; 14:664-667.
9 +
Darling RC, Austin WG, Linton RR:  Arterial embolism . Surg Gynecol Obstet 1967;;124:106-114.
10 +
Hart RG, Coull BM, Hart D:  Early recurrent embolism associated with nonvalvular atrial fibrillation: A retrospective study . Stroke 1983;;14:688-693.
11 +
Britton M, Gustafsson C:  Nonrheumatic atrial fibrillation as a risk factor for stroke . Stroke 1985;;16:182-188.
12 +
Mohr JP, Caplan LR, Melski JW, et al:  The Harvard Cooperative Stroke Registry: A prospective registry . Neurology 1978;;28:754-762.
13 +
Jorgensen L, Torvik A:  Ischemie cerebrovascular diseases in an autopsy series: Part I . J Neurol Sci 1966;;3:490-509.
14 +
Bar-Sela S, Ehrenfeld M, Eliakim M:  Arterial embolism in thyrotoxicosis with atrial fibrillation . Arch Intern Med 1981;;141:1191-1192.
15 +
Close JB, Evans DW, Bailey SM:  Persistent lone atrial fibrillation: Its prognosis after clinical diagnosis . J R Coll Gen Pract 1979;;29:547-549.
16 +
Harrison MJG, Marshall J:  Atrial fibrillation, TIAs and completed strokes . Stroke 1984;; 15:441-442.
17 +
Forfar JC:  Prediction of hemorrhage during long-term oral coumarin anticoagulation . Am Heart J 1982;;103:445-447.
18 +
Whisnant JP, Cartlidge NE, Elveback LR:  Carotid and vertebral-basilar TIA: Effect of anticoagulants, hypertension and cardiac disorders on survival and stroke occurrence . Ann Neurol 1978;;3:107-115.
19 +
Nunez L, Aguado MG, Larrea JL, et al:  Prevention of thromboembolism using aspirin after mitral valve replacement with porcine bioprosthesis . Ann Thorac Surg 1984;;37:84-87.
20 +
Kelley RE, Berger JR, Alter M, et al:  Cerebral ischemia and atrial fibrillation . Neurology 1985;;35:938-939.
21 +
Santamaria J, Graus F, Peres J:  Cerebral embolism and anticoagulation . Neurology 1983;; 33:1104.
22 +
Cerebral Embolism Study Group:  Immediate anticoagulation of embolic stroke: Brain hemorrhage and management options . Stroke 1984;;779-789.
23 +
Cerebral Embolism Study Group:  Immediate anticoagulation of embolic stroke: A randomized trial . Stroke 1983;;14:668-676.

Correspondence

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems