Anticoagulation in patients at high risk of stroke without documented atrial fibrillation. Time for a paradigm shift?

Research output: Contribution to journalArticle

Abstract

Atrial fibrillation (AF) is currently considered a risk factor for stroke. Depending on the severity of clinical factors (risk scores) a recommendation for full anticoagulation is made. Although AF is most certainly a risk factor for ischemic stroke, it is not necessarily the direct cause of it. The causality of association between AF and ischemic stroke is questioned by the reported lack of temporal relation between stroke events and AF paroxysms (or atrial high-rate episodes detected by devices). In different studies, only 2% of patients had subclinical AF > 6 minutes in duration at the time of stroke or systemic embolism. Is it time to consider AF only one more factor of endothelial disarray rather than the main contributor to stroke? In this “opinion paper” we propose to consider not only clinical variables predicting AF/stroke but also electrocardiographic markers of atrial fibrosis, as we postulate this as a strong indicator of risk of AF/stroke. We ask if it is time to change the paradigm and to consider, in some special situations, to protect patients (preventing stroke) who have no evidence of AF.

Details

Authors
Organisations
External organisations
  • Hospital de Sant Pau
  • Queen's University
  • Complutense University of Madrid
  • Skåne University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems
Original languageEnglish
Article numbere12417
JournalAnnals of Noninvasive Electrocardiology
Volume22
Issue number1
Publication statusPublished - 2017 Jan 1
Publication categoryResearch
Peer-reviewedYes