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Prevention of Stroke in Nonvalvular Atrial Fibrillation

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Key Points ÎÎThe absolute risk of stroke varies 20-fold among AF patients according to age and associated vascular comorbidities. Current AHA guidelines use the CHADS2 stratification scheme. ÎÎThe major risk of antithrombotic medications used to lower the incidence of AF-related stroke is bleeding. •  For warfarin, this involves balancing a bleeding risk of 1% to 12% per year. ÎÎThe advent of several new antithrombotic agents offers alternatives to warfarin and may lower the thromboembolic risk threshold for initiating therapy in patients with AF. Diagnosis Table 1. Stroke Risk in Patients With Nonvalvular AF Not Treated With Anticoagulation According to the CHADS2 Index CHADS2 Risk Criteria Score Congestive heart failure Hypertension Age 75 y Diabetes mellitus Prior Stroke or TIA 1 1 1 1 2 Adjusted Stroke Rate (%/y) Patients (N = 1733) (95% CI) CHADS2 Score 120 1.9 (1.2-3.0) 0 463 2.8 (2.0-3.8) 1 523 4.0 (3.1-5.1) 2 337 5.9 (4.6-7.3) 3 220 8.5 (6.3-11.1) 4 65 12.5 (8.2-17.5) 5 5 18.2 (10.5-27.4) 6

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