6. Importance
• Patients with AF even on optimum medical
therapy, have higher mortality than those with
Normal Sinus .
• Risk of stroke in non-valvular AF is 5 times
than those without, in case of valvular AF
riskis even much higher 18-23 times.
7. AF & Stroke
• AF is responsible for 15 % of all strokes.
• AF is the most important cause of stroke in
women above the age of 75 years.
8. AF & risk of stroke (CHADS2)
Risk of stroke(up to 20 fold) varies
depending on the clinical picture
Score(points) Prevalence(%)
Prior stroke or TIA 2 10
Age > 75 years 1 28
Hypertension 1 65
Diabetes Mellitus 1 18
Heart Failure 1 32
9. CHADS score , risk of stroke
Score ( points) Stroke Rate % per year VKAs vs. no VKAs crude
ratio( 95% relative risk)
0 0.5-2.2 0.50 (0.20-1.28)
1 2.0-4.5 0.47(0.30-0.73)
2 0.51(0.35-0.75)
3 0.42(0.28-0.62)
4 6-12 0.30(0.20-0.75)
5 0.67(0.28-1.60)
10. Rate or Rhythm
• AFFIRM trial showed no mortality difference.
• AF-CHF , showed even in heart failure, no
difference in mortality between the two
strategies.
12. Ximelagatran (Exanta)
First ever oral thrombin inhibitor
• Now out of clinical use due to liver toxicity
10%.
• Studied in Phase III trials like SPORTIF III(3407
patients ) SPORTIF V (3922 patients) vs.
warfarin.
• Rate of stroke was similar 1.6 % per annum,
marginally less bleeding with Ximelagatran
13. Idraparinux
Long acting Xa Inhibitor (once a WK)
• In the AMADEUS trial(4576 patients),
Idraparinux was non inferior to warfarin but
more risk of bleeding 19 % vs. 11%