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CLC number: R541.7+5

On-line Access: 2012-08-01

Received: 2012-06-26

Revision Accepted: 2012-07-09

Crosschecked: 2012-07-17

Cited: 4

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Journal of Zhejiang University SCIENCE B 2012 Vol.13 No.8 P.609-615


Clinical considerations of anticoagulation therapy for patients with atrial fibrillation

Author(s):  Shu Zhang

Affiliation(s):  Arrhythmias Center and Clinical EP Lab., Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China

Corresponding email(s):   zsfuwai@vip.163.com

Key Words:  Anticoagulation therapy, Atrial fibrillation, Warfarin, Dabigatran, Riveroxaban, Apixaban

Shu Zhang. Clinical considerations of anticoagulation therapy for patients with atrial fibrillation[J]. Journal of Zhejiang University Science B, 2012, 13(8): 609-615.

@article{title="Clinical considerations of anticoagulation therapy for patients with atrial fibrillation",
author="Shu Zhang",
journal="Journal of Zhejiang University Science B",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%T Clinical considerations of anticoagulation therapy for patients with atrial fibrillation
%A Shu Zhang
%J Journal of Zhejiang University SCIENCE B
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%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1201007

T1 - Clinical considerations of anticoagulation therapy for patients with atrial fibrillation
A1 - Shu Zhang
J0 - Journal of Zhejiang University Science B
VL - 13
IS - 8
SP - 609
EP - 615
%@ 1673-1581
Y1 - 2012
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1201007

atrial fibrillation (AF) increases the risk of stroke. New anticoagulation agents have recently provided alternative and promising approaches. This paper reviews the current state of anticoagulation therapy in AF patients, focusing on various clinical scenarios and on comparisons, where possible, between western and eastern populations.

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article


[1]Agarwal, S., Hachamovitch, R., Menon, V., 2012. Current trial-associated outcomes with warfarin in prevention of stroke in patients with nonvalvular atrial fibrillation: a meta-analysis. Arch. Intern. Med., 172(8):623-631.

[2]Ahmed, I., Gertner, E., Nelson, W.B., House, C.M., Dahiya, R., Anderson, C.P., Benditt, D.G., Zhu, D.W., 2010. Continuing warfarin therapy is superior to interrupting warfarin with or without bridging anticoagulation therapy in patients undergoing pacemaker and defibrillator implantation. Heart Rhythm, 7(6):745-749.

[3]Beasley, B.N., Unger, E.F., Temple, R., 2011. Anticoagulant options―why the FDA approved a higher but not a lower dose of dabigatran. N. Engl. J. Med., 364(19):1788-1790.

[4]Benjamin, E.J., Wolf, P.A., D′Agostino, R.B., Silbershatz, H., Kannel, W.B., Levy, D., 1998. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation, 98(10):946-952.

[5]Boriani, G., Botto, G.L., Padeletti, L., Santini, M., Capucci, A., Gulizia, M., Ricci, R., Biffi, M., de Santo, T., Corbucci, G., et al., 2011. Improving stroke risk stratification using the CHADS2 and CHA2DS2-VASc risk scores in patients with paroxysmal atrial fibrillation by continuous arrhythmia burden monitoring. Stroke, 42(6):1768-1770.

[6]Brinker, J., 2012. Device surgery in the anticoagulated patient: the Goldilocks principle. Heart Rhythm, 9(3):368-369.

[7]Calkins, H., Kuck, K.H., Cappato, R., Brugada, J., Camm, A.J., Chen, S.A., Crijns, H.J., Damiano, R.J.Jr., Davies, D.W., DiMarco, J., et al., 2012. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm., 9(4):632-696.e21.

[8]Camm, A.J., Kirchhof, P., Lip, G.Y., Schotten, U., Savelieva, I., Ernst, S., van Gelder, I.C., Al-Attar, N., Hindricks, G., Prendergast, B., et al., 2010. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur. Heart J., 31(19):2369-2429.

[9]Cano, O., Munoz, B., Tejada, D., Osca, J., Sancho-Tello, M.J., Olague, J., Castro, J.E., Salvador, A., 2012. Evaluation of a new standardized protocol for the perioperative management of chronically anticoagulated patients receiving implantable cardiac arrhythmia devices. Heart Rhythm, 9(3):361-367.

[10]Connolly, S.J., Ezekowitz, M.D., Yusuf, S., Eikelboom, J., Oldgren, J., Parekh, A., Pogue, J., Reilly, P.A., Themeles, E., Varrone, J., et al., 2009. Dabigatran versus warfarin in patients with atrial fibrillation. N. Engl. J. Med., 361(12):1139-1151.

[11]Douketis, J.D., Spyropoulos, A.C., Spencer, F.A., Mayr, M., Jaffer, A.K., Eckman, M.H., Dunn, A.S., Kunz, R., 2012. Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 141(2 Suppl.):e326S-e350S.

[12]Fuster, V., Ryden, L.E., Cannom, D.S., Crijns, H.J., Curtis, A.B., Ellenbogen, K.A., Halperin, J.L., Kay, G.N., le Huezey, J.Y., Lowe, J.E., et al., 2011. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J. Am. Coll. Cardiol., 57(11):e101-e198.

[13]Gage, B.F., Waterman, A.D., Shannon, W., Boechler, M., Rich, M.W., Radford, M.J., 2001. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA, 285(22):2864-2870.

[14]Go, A.S., Hylek, E.M., Phillips, K.A., Chang, Y., Henault, L.E., Selby, J.V., Singer, D.E., 2001. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA, 285(18):2370-2375.

[15]Granger, C.B., Alexander, J.H., McMurray, J.J., Lopes, R.D., Hylek, E.M., Hanna, M., Al-Khalidi, H.R., Ansell, J., Atar, D., Avezum, A., et al., 2011. Apixaban versus warfarin in patients with atrial fibrillation. N. Engl. J. Med., 365(11):981-992.

[16]Hakalahti, A., Uusimaa, P., Ylitalo, K., Raatikainen, M.J., 2011. Catheter ablation of atrial fibrillation in patients with therapeutic oral anticoagulation treatment. Europace, 13(5):640-645.

[17]Hammerstingl, C., Omran, H., 2011. Perioperative bridging of chronic oral anticoagulation in patients undergoing pacemaker implantation―a study in 200 patients. Europace, 13(9):1304-1310.

[18]Hart, R.G., Pearce, L.A., Aguilar, M.I., 2007. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann. Intern. Med., 146(12):857-867.

[19]Heneghan, C., Ward, A., Perera, R., Bankhead, C., Fuller, A., Stevens, R., Bradford, K., Tyndel, S., Alonso-Coello, P., Ansell, J., et al., 2012. Self-monitoring of oral anticoagulation: systematic review and meta-analysis of individual patient data. Lancet, 379(9813):322-334.

[20]JCS Joint Working Group, 2010. Guidelines for pharmacotherapy of atrial fibrillation (JCS 2008): digest version. Circ. J., 74(11):2479-2500.

[21]Krahn, A.D., Manfreda, J., Tate, R.B., Mathewson, F.A., Cuddy, T.E., 1995. The natural history of atrial fibrillation: incidence, risk factors, and prognosis in the manitoba follow-up study. Am. J. Med., 98(5):476-484.

[22]Lip, G.Y., Nieuwlaat, R., Pisters, R., Lane, D.A., Crijns, H.J., 2010. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest, 137(2):263-272.

[23]Mega, J.L., 2011. A new era for anticoagulation in atrial fibrillation. N. Engl. J. Med., 365(11):1052-1054.

[24]Miyasaka, Y., Barnes, M.E., Gersh, B.J., Cha, S.S., Bailey, K.R., Abhayaratna, W.P., Seward, J.B., Tsang, T.S., 2006. Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000, and implications on the projections for future prevalence. Circulation, 114(2):119-125.

[25]Patel, M.R., Mahaffey, K.W., Garg, J., Pan, G., Singer, D.E., Hacke, W., Breithardt, G., Halperin, J.L., Hankey, G.J., Piccini, J.P., et al., 2011. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N. Engl. J. Med., 365(10):883-891.

[26]Pengo, V., Cucchini, U., Denas, G., Davidson, B.L., Marzot, F., Jose, S.P., Iliceto, S., 2010. Lower versus standard intensity oral anticoagulant therapy (OAT) in elderly warfarin-experienced patients with non-valvular atrial fibrillation. Thromb. Haemost., 103(2):442-449.

[27]Pisters, R., Lane, D.A., Nieuwlaat, R., de Vos, C.B., Crijns, H.J., Lip, G.Y., 2010. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest, 138(5):1093-1100.

[28]Quintela, S., Villaran, M.C., de Armentia, I.L., Elejalde, E., 2012. Ochratoxin A removal from red wine by several oenological fining agents: bentonite, egg albumin, allergen-free adsorbents, chitin and chitosan. Food Addit. Contam.: Part A: Chem. Anal. Control Expo. Risk Assess., 29(7):1168-1174.

[29]Santangeli, P., di Biase, L., Horton, R., Burkhardt, J.D., Sanchez, J., Al-Ahmad, A., Hongo, R., Beheiry, S., Bai, R., Mohanty, P., et al., 2012. Ablation of atrial fibrillation under therapeutic warfarin reduces periprocedural complications: evidence from a meta-analysis. Circ. Arrhythm. Electrophysiol., 5(2):302-311.

[30]Shen, A.Y., Yao, J.F., Brar, S.S., Jorgensen, M.B., Chen, W., 2007. Racial/ethnic differences in the risk of intracranial hemorrhage among patients with atrial fibrillation. J. Am. Coll. Cardiol., 50(4):309-315.

[31]Sinnaeve, P.R., Brueckmann, M., Clemens, A., Oldgren, J., Eikelboom, J., Healey, J.S., 2012. Stroke prevention in elderly patients with atrial fibrillation: challenges for anticoagulation. J. Intern. Med., 271(1):15-24.

[32]Stewart, S., Hart, C.L., Hole, D.J., McMurray, J.J., 2002. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am. J. Med., 113(5):359-364.

[33]van Walraven, C., Hart, R.G., Singer, D.E., Laupacis, A., Connolly, S., Petersen, P., Koudstaal, P.J., Chang, Y., Hellemons, B., 2002. Oral anticoagulants vs. aspirin in nonvalvular atrial fibrillation: an individual patient meta-analysis. JAMA, 288(19):2441-2448.

[34]Verma, A., Tsang, B., 2012. The use of anticoagulation during the periprocedure period of atrial fibrillation ablation. Curr. Opin. Cardiol., 27(1):55-61.

[35]Vidaillet, H., Granada, J.F., Chyou, P.H., Maassen, K., Ortiz, M., Pulido, J.N., Sharma, P., Smith, P.N., Hayes, J., 2002. A population-based study of mortality among patients with atrial fibrillation or flutter. Am. J. Med., 113(5):365-370.

[36]Wolf, P.A., Abbott, R.D., Kannel, W.B., 1987. Atrial fibrillation: a major contributor to stroke in the elderly. The Framingham Study. Arch. Intern. Med., 147(9):1561-1564.

[37]Wolf, P.A., Abbott, R.D., Kannel, W.B., 1991. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke, 22(8):983-988.

[38]Zhang, S., 2009. Atrial fibrillation in mainland China: epidemiology and current management. Heart, 95(13):1052-1055.

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