The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Predictors of Thromboembolism in Atrial Fibrillation: I. Clinical Features of Patients at Risk

The Stroke Prevention in Atrial Fibrillation Investigators*
[+] Article, Author, and Disclosure Information

Grant Support: By grant R01-NS-24224 from the Division of Stroke and Trauma, National Institute of Neurological Disorders and Stroke.

Requests for Reprints: Lesly A. Pearce, MS, SPAF Statistical Coordinating Center, Statistics & Epidemiology Research Corporation, 1107 NE 45th Street, Suite 520, Seattle, WA 98105.

*For a list of participating investigators, see end of text.

© 1992 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1992;116(1):1-5. doi:10.7326/0003-4819-116-1-1
Text Size: A A A

Objective: To identify those patients with nonrheumatic atrial fibrillation who are at high risk and those at low risk for arterial thromboembolism.

Design: Cohort study of patients assigned to placebo in a randomized clinical trial.

Setting: Five hundred sixty-eight inpatients and outpatients with nonrheumatic atrial fibrillation assigned to placebo therapy at 15 U.S. medical centers from 1987 to 1989 in the Stroke Prevention in Atrial Fibrillation study. Patients were followed for a mean of 1.3 years.

Measurements: Clinical variables were assessed at study entry and correlated with subsequent ischemic stroke and systemic embolism by multivariate analysis.

Main Results: Recent (within 3 months) congestive heart failure, a history of hypertension, and previous arterial thromboembolism were each significantly and independently associated with a substantial risk for thromboembolism (> 7% per year; P ≤ 0.05). The presence of these three independent clinical predictors (recent congestive heart failure, history of hypertension, previous thromboembolism) defined patients with rates of thromboembolism of 2.5% per year (no risk factors), 7.2% per year (one risk factor), and 17.6% per year (two or three risk factors). Nondiabetic patients without these risk factors, comprising 38% of the cohort, had a low risk for thromboembolism (1.4% per year; 95% Cl, 0.05% to 3.7%). Patients without clinical risk factors who were under 60 years of age had no thromboembolic events.

Conclusion: Patients with atrial fibrillation at high risk (> 7% per year) and low risk (< 3% per year) for thromboembolism can be identified by readily available clinical variables.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.