Clinical implication of antiembolic trials in atrial fibrillation and roleof transesophageal echocardiography in atrial fibrillation

Risk for stroke in patients with atrial fibrillation (AF) is highly heterog enous. Increasing age, history of diabetes, hypertension, previous transien t ischemic attack or stroke, and poor ventricular function are independent risk factors for stroke in patients with AF. Accordingly, some groups of pa tients with AF have low risk and some have high risk, in general, patients at high risk benefit most from anticoagulation therapy with warfarin. In ge neral, if a patient is younger than 65 years of age and has none of the def ined risk factors, the stroke rate without prophylaxis (aspirin or warfarin ) is low. In patients 65 to 75 years of age with no risk factors, the risk for stroke is low with either aspirin or warfarin therapy; the choice is le ft to the caretaking physician. All patients older than 75 years and all pa tients of any age who have risk factors obtain striking benefit from the us e of anticoagulation with warfarin. This benefit far outweighs any risk for major hemorrhage. Curr Opin Cardiol 2000, 15:58-63 (C) 2000 Lippincott Wil liams & Wilkins, Inc.