Journal of Arrhythmia (Jan 2009)

Antithrombotic Therapy According to the Guidelines Issued by the Japanese Circulation Society in Patients with Nonvalvular Paroxysmal Atrial Fibrillation without Thromboembolic Risk Factors

  • Mahito Ozawa, MD,
  • Takashi Komatsu, MD,
  • Hideaki Tachibana, MD,
  • Yoshihiro Sato, MD,
  • Makoto Orii, MD,
  • Fusanori Kunugita, MD,
  • Motoyuki Nakamura, MD

DOI
https://doi.org/10.1016/S1880-4276(09)80021-5
Journal volume & issue
Vol. 25, no. 2
pp. 81 – 88

Abstract

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Aim and method: There have been few reports about the risk of ischemic stroke in elderly patients with non-valvular paroxysmal atrial fibrillation (NVPAF). The aim of this study was to evaluate the validity of the guidelines issued by the Japanese Circulation Society to prevent ischemic stroke for NVPAF in patients without a high risk of ischemic stroke. The risk evaluation was made based on the CHADS2 Score. However, we excluded age in this study, but included coronary disease. This study investigated a total of 150 patients with paroxysmal atrial fibrillation (AF) who did not have a high risk of stroke (117 men and 33 women, mean age 68 ± 12 years). The patients were divided into three groups according to age: the patients who were less than 60 years old (Group I, N = 58, Antithrombic therapy (+) = 18), those who were between 60 and 75 years old (Group II, N = 68, Antithrombic therapy (+) = 36) and those who were more than 75 years old (Group III, N = 24, Antithrombic therapy (+) = 7). The annual rates of thromboembolism among three groups were retrospectively analyzed. The mean follow-up periods were 56 ± 37 months. Results: (1) The annual rate of thromboembolism in Group III (4.0%) was significantly higher than in Group I (1.4%) and Group II (1.8%) (P < 0:05). (2) The annual rates of thromboembolism in patients without antithrombotic therapy were 2.1% in Group I, 1.3% in Group II and 3.9% in Group III. The annual rate was significantly lower in Group II than in Group III (P < 0:05). (3) The annual rates of thromboembolism with aspirin treatment (80- 100 mg/day) were 0% in Group I, 3.0% in Group II and 8.4% in Group III. There was a significant difference in the annual rate among the three groups (P < 0:05). (4) The annual rate of thromboembolism in patients with warfarin treatment was 0% in Group I, 1.5% in Group II and 0% in Group III (P = NS among 3 groups). Conclusion: Antithrombic therapy is required in elderly patients with NVPAF to prevent ischemic stroke. Antithrombic therapy with Warfarin, but not aspirin, reduces ischemic stroke in patients with NVPAF regardless of their age.

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