The full content of Annals is available to subscribers

Subscribe/Learn More  >
Updates |

Atrial Fibrillation and Thromboembolism: A Decade of Progress in Stroke Prevention

Robert G. Hart, MD; and Jonathan L. Halperin, MD
[+] Article, Author, and Disclosure Information

From University of Texas Health Sciences Center, San Antonio, Texas; and Mount Sinai Medical Center, New York, New York.

Note: Both authors were participants in the Stroke Prevention in Atrial Fibrillation I, II, and III clinical trials.

Requests for Reprints: Robert G. Hart, MD, Department of Medicine (Neurology), University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78284; e-mail, hartr@uthscsa.edu. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Dr. Hart: Department of Medicine (Neurology), University of Texas Health Science Center, 7703 Floyd Curl Drive, San Antonio, TX 78284.

Dr. Halperin: The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029.

Ann Intern Med. 1999;131(9):688-695. doi:10.7326/0003-4819-131-9-199911020-00010
Text Size: A A A

By the late 1970s, nonvalvular atrial fibrillation was identified as an independent risk factor for stroke (14), and millions of people with this common cardiac dysrhythmia were designated as having substantial risk for cardiogenic embolism (5). One of every six strokes occurs in a patient with atrial fibrillation, and about 10% of all ischemic strokes are probably due to embolism of left atrial thrombi. In the past decade, randomized clinical trials assessed the efficacy of antithrombotic therapies for stroke prevention in patients with nonvalvular atrial fibrillation. Eighteen trials involving more than 10 000 participants with atrial fibrillation have compared anticoagulants and antiplatelet agents, alone and in combination, with placebo and with each other (6). The remarkable pace of development has revolutionized management of this long-neglected dysrhythmia and makes detection of atrial fibrillation an important opportunity for stroke prevention. We present recent advances, discuss controversies, and explore new ideas about stroke and its prevention in patients with nonvalvular atrial fibrillation. We searched the MEDLINE database using the key words atrial fibrillation, thromboembolism, antithrombotic therapy, anticoagulation, stroke, warfarin, and aspirin.

First Page Preview

View Large
First page PDF preview





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 $32.00

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.