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(Circulation. 2009;120:1927-1932.)
© 2009 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

Does left atrial appendage occlusion eliminate the need for warfarin?

Left Atrial Appendage Occlusion Does Not Eliminate the Need for Warfarin

Richard P. Whitlock, MD, MSc; Jeff S. Healey, MD; Stuart J. Connolly, MD

From the Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.

Correspondence to Dr Richard Whitlock, Suite 4E-422, 237 Barton St E, Hamilton, Ontario, Canada. E-mail richard.whitlock@phri.ca

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
A trial fibrillation (AF) is the most common sustained heart rhythm disorder. It is increasing in incidence, which has major societal implications for our aging population.^1–3 It is estimated to affect 1% to 1.5% of the developed world, and the incidence increases with age to a rate of 19.2 per 1000 patient-years in those 65 years of age and older. The most important aspect of the treatment of patients with AF is the prevention of stroke. The average annual stroke rate across risk groups is 5%, and AF-associated strokes confer worse outcomes than those occurring in the absence of AF.^1,4 Furthermore, Stroke Prevention in Nonrheumatic Atrial Fibrillation (SPINAF) data suggest that 15% of patients with AF suffer silent cerebral infarctions on computed tomography, the implications of which are unknown.⁵

Response by Holmes and Schwartz on p 1932

Oral anticoagulant (OAC) therapy with warfarin has been established as the standard for stroke prevention in patients with AF and more than 1 risk factor for stroke.⁶ Hart et al have summarized this literature in meta-analyses that include 29 trials and 28 044 patients.^7,8 Compared with placebo, warfarin reduced the rate of stroke by 64% (95% confidence interval [CI], 49% to 74%), and in trials of warfarin versus antiplatelet, warfarin reduced the rate of stroke by 37% (95% CI, 23% to 48%). This is a large treatment effect when compared with other drug therapies in cardiovascular medicine. Further, even with an absolute risk increase in intracerebral hemorrhage and major hemorrhage of 0.2% per . . . [Full Text of this Article]