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High incidence of asymptomatic AF

High incidence of asymptomatic AF. 110 patients with history of paroxysmal/persistent AF but in sinus rhythm at baseline. All patients received antiarrhythmic drug therapy. AF detected by implanted monitoring pacemaker. 100. 80. P < 0.0001. 60. Patients. 40.

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High incidence of asymptomatic AF

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  1. High incidence of asymptomatic AF 110 patients with history of paroxysmal/persistent AF but in sinusrhythm at baseline. All patients received antiarrhythmic drug therapy AF detected by implanted monitoring pacemaker 100 80 P < 0.0001 60 Patients 40 AF detected by ECG at follow-up (FU) visit 20 0 Baseline FU1 FU2 FU3 FU4 FU5 FU6 FU7 FU8 FU9 FU10 n 110 110 110 110 85 73 60 48 39 25 15 Israel CW et al. J Am Coll Cardiol. 2004:43:47-52.

  2. High incidence of asymptomatic AF: Clinical implications “The implications for treatment are clear, namely that apparent freedom from AF does not, per se, obviate the need for oral anticoagulation.” Kaufman ES, Waldo AL. J Am Coll Cardiol. 2004;43:53-4.

  3. INR Odds ratio* (3-mos mortality) <2.0 2.0–3.0 >3.0 1.9 2.7 5.5 Warfarin increases hemorrhagic stroke mortality Lobar ICH Deep hemispheric ICH 60 60 57.6 40 40 44.2 %Patients 28.6 20 20 22.5 0 0 Nowarfarin Warfarin Nowarfarin Warfarin ICH = intracerebral hemorrhage *Relative to no warfarin; P < 0.01 for trend across INR categories Rosand J et al. Arch Intern Med. 2004;164:880-4.

  4. Trials of emerging antithrombotic therapiesfor stroke prevention in AF Trial Treatment Status AMADEUS Idraparinux* vs warfarin Ongoing ACTIVE Clopidogrel + aspirin Ongoingvs warfarin (ACTIVE W) or vs aspirin (ACTIVE A) SPORTIF III/V Ximelagatran vs warfarin Completed Hankey GJ et al. Stroke. 2004;35:389-91. *Administered sc 1/week

  5. SPORTIF III and V pooled results: Primary outcome Ximelagatran better Warfarin better –0.66 P = 0.10 SPORTIF III +0.45 P = 0.13 SPORTIF V –0.03 Pooled P = 0.94 Noninferiority -4 -3 -2 -1 0 1 2 3 4 Difference in absolute event rates (ximelagatran – warfarin) Stroke Prevention using an ORal ThrombinInhibitor in patients with atrial Fibrillation Halperin JL. AHA Scientific Sessions 2003; Orlando, Fla.

  6. SPORTIF III and V pooled results: Net clinical benefit On-treatment analysis Warfarin Ximelagatran Primary events + major bleeding + death 10 RRR = 26%P = 0.019 RRR = 7%P = 0.527 RRR = 16%P = 0.038 8 Eventrate(%/year) 6 6.1 6.3 6.2 5.8 5.2 4 4.6 2 0 SPORTIF III SPORTIF V Pooled RRR = relative risk reduction Stroke Prevention using an ORal ThrombinInhibitor in patients with atrial Fibrillation Halperin JL. AHA Scientific Sessions 2003; Orlando, Fla.

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