Robert M. Centor, MD; Gustavo R. Heudebert, MD
Disclosures: Dr. Centor has disclosed the following: Honoraria: Medscape. Dr. Heudebert has no interests or financial relationships to disclose.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Proctor & Gamble, Pfizer, and Johnson & Johnson. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
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.
Audio. Annals On Call - Estimating Stroke Risk in Atrial Fibrillation: Dr. Centor discusses the estimation of stroke risk in patients with atrial fibrillation with Dr. Gustavo Heudebert, a professor of medicine at the University of Alabama.
Other Audio Options: Download MP3
No institutional affiliation
February 19, 2019
Reducing Stroke Risk from Atrial Fibrillation
Atrial fibrillation has been found to have much higher prevalence in the sleep apnea population relative to that in the general population – 5:1. Because of that high ratio, AF is the comorbidity of sleep apnea which is the strongest indicator of its presence . Sleep apnea has also been shown to lead to hypercoagulabulity . These two factors combine to significantly elevate the risk for ischemic stroke. Fortunately both factors may be reversible by overcoming the sleep apnea, even though it may take six months or longer for that to occur completely. During that period of time, the use of an anticoagulation drug may be indicated, but the blood would have to be frequently titred to appropriately reduce the drug dosage until finally discontinuing it.1. Abrams B. Hierarchy of comorbidity indicators for obstructive sleep apnea. Chest. 2010 Jun;137(6): 1491-2.2. Toraldo DM, De Benedetto M, Scoditti E, De Nuccio F. Obstructive sleep apnea syndrome: coagulation anomalies and treatment with continuous positive airway pressure. Sleep Breath. 2016 May;20(2): 457-65.
Atrial fibrillation and sleep apena
Thanks for your comment. I agree 100%.
Centor RM, Heudebert GR. Annals On Call - Estimating Stroke Risk in Atrial Fibrillation. Ann Intern Med. 2019;170:OC1. doi: 10.7326/A18-0014
Download citation file:
Published: Ann Intern Med. 2019;170(4):OC1.
Cardiology, Neurology, Rhythm Disorders and Devices, Stroke.
Results provided by:
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use