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Should we abandon the common practice of withholding oral anticoagulation in paroxysmal atrial fibrillation?Nieuwlaat R; Dinh T; Olsson SB; Camm AJ; Capucci A; Tieleman RG; Lip GY; Crijns HJEur Heart J 2008[Apr]; 29 (7): 915-22AIMS: 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.|Administration, Oral[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Anticoagulants/*administration & dosage[MESH]|Aspirin/*administration & dosage[MESH]|Atrial Fibrillation/*complications/therapy[MESH]|Electric Countershock/adverse effects[MESH]|Electrocardiography[MESH]|Female[MESH]|Fibrinolytic Agents/*administration & dosage[MESH]|Follow-Up Studies[MESH]|Humans[MESH]|Male[MESH]|Risk Factors[MESH]|Stroke/etiology/*prevention & control[MESH]|Treatment Outcome[MESH]|Withholding Treatment[MESH] |
