The risk of embolic stroke in patients with atrial fibrillation is
largely related to the underlying disorders responsible for the
arrhythmia. Atrial fibrillation associated with rheumatic mitral
valve disease has the highest stroke risk (about 17 times greater
than unaffected controls), but even with nonvalvular heart disease, the risk is increased fivefold. The stroke risk is greater with
chronic than with paroxysmal atrial fibrillation, is highest in the
year after onset of the arrhythmia, and is lower in younger patients with idiopathic ("lone") atrial fibrillation. Major bleeding
episodes, the most important risk of anticoagulation, occur in
about 5% to 10% of patients. The decision to anticoagulate a
patient with atrial fibrillation depends on the cause of the arrhythmia, especially any associated cardiovascular disease, and the
individual's risk from anticoagulation. Growing evidence supports the effectiveness of anticoagulation of most patients with
nonvalvular, as well as valvular, cardiac disease for the prevention of both primary and recurrent strokes.
(Arch Intern Med. 1990;150:1598-1603)
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