Stroke risk increases significantly in AF patients

Patients with atrial fibrillation (AF) who are over age 65 are 5 to 7 times more likely to have a stroke than same-aged patients without the condition, said Daniel Tambunan, MD, Assistant Director, Family Practice Residency, Florida Hospital, Orlando, Fla.

Stroke rates with AF increase with age and almost double every decade after age 60, he added. Certain clinical risk factors will also increase the risk of stroke in these patients. For example, a patient with a previous stroke or transient ischemic attack (TIA) is 2.5 times as likely to have another event than patients without this history. Other factors that increase risk include a history of hypertension (1.6-fold increase), diabetes (1.7), and increasing age per decade (1.4).

"Reviewing these risk factors is very important in evaluating patients for therapy," noted Dr Tambunan.

The therapies of choice for stroke prevention in patients with AF are aspirin and warfarin. Aspirin is recommended for patients under age 65 who have do not have the major risk factors such as a previous event, hypertension, or diabetes.

Aspirin or warfarin can be used in patients age 65 to 75 with no risk factors. Warfarin is recommended for older patients and all patients with risk factors.

Dr Tambunan noted that, despite the utility of warfarin in these patients, the drug is not prescribed as a stroke preventative as much as it might be. Fear of falls and related bleeds are the reason, he said. However, he noted that the risk of a stroke might outweigh the risk of a bleed.