Editorial

Stroke in Atrial Fibrillation: A Need for Effective Anticoagulation

Authors: Vishal Bhatia, MD

Abstract

Atrial fibrillation (AF) occurs in 2 to 4% of the population aged 60 years and older and in up to 10% of the population above the age of 80 years. In the Framingham study, AF was found to be responsible for approximately one-sixth of all ischemic strokes in people older than 60 years of age.1 In addition to causing clinical stroke with major deficits, AF is also associated with silent cerebral infarctions.2,3 Paroxysmal AF, which usually lasts less than 7 days and is usually asymptomatic, can also cause embolization with almost the same risk as persistent AF.4,5 Furthermore embolic events can even occur in patients with acute AF for as little as 72 hours. The AFFIRM and RACE trials have demonstrated that embolic events occur with equal frequency regardless of whether a rate control or rhythm control strategy is pursued in the management of AF. Hence most patients with AF, regardless of whether a rate control or rhythm control strategy is chosen, should be on long-term anticoagulants with an international normalized ratio (INR) in the therapeutic range.

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