Rockson Stanley G, Albers Gregory W
Division of Cardiovascular Medicine, Falk Cardiovascular Research Center, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA.
J Am Coll Cardiol. 2004 Mar 17;43(6):929-35. doi: 10.1016/j.jacc.2003.11.028.
Atrial fibrillation (AF) is an important risk factor for stroke. According to a pooled analysis of controlled clinical trials with warfarin, anticoagulation therapy reduces stroke risk by 62%. However, clinicians must decide whether the benefit of long-term anticoagulation therapy with available agents outweighs the risk of bleeding for individual patients. Guidelines issued by the American College of Chest Physicians and by the joint American College of Cardiology, American Heart Association, and the European Society of Cardiology task force recommend antithrombotic therapy to protect AF patients from stroke based on risk-stratification algorithms. Risk factors for stroke AF patients include age > or =75 years; hypertension; thyrotoxicosis; diabetes; cardiovascular disease; congestive heart failure; and history of stroke, transient ischemic attack, or thromboembolism. Patients at high risk for stroke experience greater absolute benefit from anticoagulation therapy than patients at low risk. The guidelines are consistent in recommendations for high-risk patients (warfarin therapy, international normalized ratio 2.0 to 3.0) and low-risk patients (aspirin 325 mg), but differ for intermediate-risk patients with diabetes or heart disease. The guidelines continue to evolve, and future guidelines are likely to incorporate new clinical data, including the CHADS(2) algorithm for determining risk and the results of the Atrial Fibrillation Follow-up Investigation of Rhythm Management trial, the Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation study, and the Stroke Prevention Using an Oral Thrombin Inhibitor in Atrial Fibrillation II to V trials.
心房颤动（AF）是卒中的一个重要危险因素。根据对华法林对照临床试验的汇总分析，抗凝治疗可使卒中风险降低62%。然而，临床医生必须判定，对于个体患者而言，使用现有药物进行长期抗凝治疗的获益是否超过出血风险。美国胸科医师学会以及美国心脏病学会、美国心脏协会和欧洲心脏病学会联合工作组发布的指南推荐，基于风险分层算法进行抗栓治疗，以保护AF患者预防卒中。AF患者的卒中危险因素包括年龄≥75岁、高血压、甲状腺毒症、糖尿病、心血管疾病、充血性心力衰竭以及卒中、短暂性脑缺血发作或血栓栓塞病史。与低风险患者相比，高风险卒中患者从抗凝治疗中获得的绝对获益更大。这些指南对于高风险患者（华法林治疗，国际标准化比值2.0至3.0）和低风险患者（阿司匹林325mg）的推荐是一致的，但对于患有糖尿病或心脏病的中度风险患者则有所不同。这些指南在持续演变，未来的指南可能会纳入新的临床数据，包括用于确定风险的CHADS(2)算法以及节律控制心房颤动随访调查试验、持续性心房颤动心率控制与电复律研究、心房颤动口服凝血酶抑制剂预防卒中II至V期试验的结果。
