Aspectos de prevención | 26 SEP 16
Prevención de ACV en la Fibrilación Auricular
Un tercio de los ACV isquémicos se producen en pacientes con fibrilación auricular no tratada o subtratada; la mayoría se podrían prevenir
Autor/a: Ben Freedman, Tatjana S Potpara, Gregory Y H Lip Lancet 2016; 388: 806–17
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REFERENCIAS
1 Jorgensen HS, Nakayama H, Reith J, Raaschou HO, Olsen TS. Acute stroke with atrial fibrillation. The Copenhagen Stroke Study. Stroke 1996; 27: 1765–69.
2 Kimura K, Minematsu K, Yamaguchi T. Atrial f brillation as a predictive factor for severe stroke and early death in 15 831 patients with acute ischaemic stroke. J Neurol Neurosurg Psychiatry 2005; 76: 679–83.
3 Marini C, De Santis F, Sacco S, et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke 2005; 36: 1115–19.
4 Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007; 146: 857–67.
5 Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014; 383: 955–62.
6 Mozaff arian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation 2016; 133: e38–360.
7 Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991; 22: 983–88.
8 Bjorck S, Palaszewski B, Friberg L, Bergfeldt L. Atrial fibrillation, stroke risk, and warfarin therapy revisited: a population-based study. Stroke 2013; 44: 3103–08.
9 Yiin GS, Howard DP, Paul NL, et al. Recent time trends in incidence, outcome and premorbid treatment of atrial fibrillation-related stroke and other embolic vascular events: a population-based study. J Neurol Neurosurg Psychiatry 2015; published online Oct 20. DOI:10.1136/jnnp-2015-311947.
10 Leyden JM, Kleinig TJ, Newbury J, et al. Adelaide Stroke Incidence Study: declining stroke rates but many preventable cardioembolic strokes. Stroke 2013; 44: 1226–31.
11 Yiin GS, Howard DP, Paul NL, et al. Age-specific incidence, outcome, cost, and projected future burden of atrial fibrillation-related embolic vascular events: a population-based study. Circulation 2014; 130: 1236–44.
12 Friberg L, Rosenqvist M, Lindgren A, Terent A, Norrving B, Asplund K. High prevalence of atrial fibrillation among patients with ischemic stroke. Stroke 2014; 45: 2599–605.
13 Li L, Yiin GS, Geraghty OC, et al. Incidence, outcome, risk factors, and long-term prognosis of cryptogenic transient ischaemic attack and ischaemic stroke: a population-based study. Lancet Neurol 2015;14: 903–13.
14 Sanna T, Diener HC, Passman RS, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med 2014; 370: 2478–86.
15 Gladstone DJ, Spring M, Dorian P, et al. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med 2014; 370: 2467–77.
16 Sposato LA, Cipriano LE, Saposnik G, Vargas ER, Riccio PM, Hachinski V. Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol 2015; 14: 377–87.
17 Hart RG, Diener HC, Coutts SB, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol 2014; 13: 429–38.
18 Ntaios G, Papavasileiou V, Milionis H, et al. Embolic strokes of undetermined source in the Athens Stroke Registry: an outcome analysis. Stroke 2015; 46: 2087–93.
19 Camm AJ, Lip GYH, Caterina RD, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. An update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 2012;33: 2719–47.
20 Diener HC, Easton JD, Granger CB, et al. Design of Randomized, double-blind, Evaluation in secondary Stroke Prevention comparing the Effi cacy and safety of the oral Thrombin inhibitor dabigatran etexilate vs. acetylsalicylic acid in patients with Embolic Stroke of Undetermined Source (RE-SPECT ESUS). Int J Stroke 2015;10: 1309–12.
21 Freedman B, Martinez C, Katholing A, Rietbrock S. Residual risk of stroke and death in anticaogulant-treated patients with atrial fibrillation. JAMA Cardiol 2016; 1: 366–68.
22 Lip GY, Al-Khatib SM, Cosio FG, et al. Contemporary management of atrial fibrillation: what can clinical registries tell us about stroke prevention and current therapeutic approaches? J Am Heart Assoc 2014; 3: e001179.
23 Kakkar AK, Mueller I, Bassand JP, et al. Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry. PLoS One 2013;8: e63479.
24 Gladstone DJ, Bui E, Fang J, et al. Potentially preventable strokes in high-risk patients with atrial fibrillation who are not adequately anticoagulated. Stroke 2009; 40: 235–40.
25 Sjalander S, Sjalander A, Svensson PJ, Friberg L. Atrial fibrillation patients do not benefi t from acetylsalicylic acid. Europace 2014;16: 631–38.
26 Ben Freedman S, Gersh BJ, Lip GY. Misperceptions of aspirin efficacy and safety may perpetuate anticoagulant underutilization in atrial fibrillation. Eur Heart J 2015; 36: 653–56.
27 Lip GY. The role of aspirin for stroke prevention in atrial fibrillation. Nat Rev Cardiol 2011; 8: 602–06.
28 NICE. Atrial fibrillation: management. NICE guidelines [CG180]. 2014. https://www.nice.org.uk/guidance/cg180?unlid=942923866201617111 (accessed Aug 10, 2016).
29 Ogawa S, Aonuma K, Tse HF, et al. The APHRS’s 2013 statement on antithrombotic therapy of patients with nonvalvular atrial fibrillation. J Arrhythm 2013; 29: 190–200.
30 Ben Freedman S, Lowres N. Asymptomatic atrial fibrillation: the case for screening to prevent stroke. JAMA 2015; 314: 1911–12.
31 Potter BJ, Le Lorier J. Taking the pulse of atrial fibrillation. Lancet 2015; 386: 113–15.
32 Martinez C, Katholing A, Freedman SB. Adverse prognosis of incidentally detected ambulatory atrial fibrillation. A cohort study. Thromb Haemost 2014; 112: 276–86.
33 Tsang TS, Barnes ME, Pellikka PA, et al. Silent atrial fibrillation in Olmsted county: a community-based study. Can J Cardiol 2011;27: S122.
34 Siontis KC, Gersh BJ, Killian JM, et al. Typical, atypical, andasymptomatic presentations of new-onset atrial fibrillation in the community: characteristics and prognostic implications. Heart Rhythm 2016; 13: 1418–24.
35 Boriani G, Laroche C, Diemberger I, et al. Asymptomatic atrial fibrillation: clinical correlates, management, and outcomes in the EORP-AF Pilot General Registry. Am J Med 2015; 128: 509–18.e2.
36 Healey JS, Connolly SJ, Gold MR, et al. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med 2012; 366: 120–29.
37 Glotzer TV, Hellkamp AS, Zimmerman J, et al. Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke: report of the Atrial Diagnostics Ancillary Study of the Mode Selection Trial (MOST). Circulation 2003; 107: 1614–19.
38 Larsen BS, Kumarathurai P, Falkenberg J, Nielsen OW, Sajadieh A. Excessive atrial ectopy and short atrial runs increase the risk of stroke beyond incident atrial fibrillation. J Am Coll Cardiol 2015;66: 232–41.
39 Brambatti M, Connolly SJ, Gold MR, et al. Temporal relationship between subclinical atrial fibrillation and embolic events. Circulation 2014; 129: 2094–99.
40 Turakhia MP, Ziegler PD, Schmitt SK, et al. Atrial fibrillation burden and short-term risk of stroke: case-crossover analysis of continuously recorded heart rhythm from cardiac electronic implanted devices. Circ Arrhythm Electrophysiol 2015; 8: 1040–47.
41 Martin DT, Bersohn MM, Waldo AL, et al. Randomized trial of atrial arrhythmia monitoring to guide anticoagulation in patients with implanted defibrillator and cardiac resynchronization devices. Eur Heart J 2015; 36: 1660–68.
42 Kamel H, Okin PM, Elkind MS, Iadecola C. Atrial fibrillation and mechanisms of stroke: time for a new model. Stroke 2016;47: 895–900.
43 Lowres N, Neubeck L, Redfern J, Freedman SB. Screening to identify unknown atrial fibrillation. A systematic review. Thromb Haemost 2013; 110: 213–22.
44 Svennberg E, Engdahl J, Al-Khalili F, Friberg L, Frykman V, Rosenqvist M. Mass screening for untreated atrial fibrillation: the STROKESTOP study. Circulation 2015; 131: 2176–84.
45 Fitzmaurice DA, Hobbs FDR, Jowett S, et al. Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial. BMJ 2007; 335: 383.
46 Lowres N, Neubeck L, Salkeld G, et al. Feasibility and cost-eff ectiveness of stroke prevention through community screening for atrial fibrillation using iPhone ECG in pharmacies. The SEARCH-AF study. Thromb Haemost 2014; 111: 1167–76.
47 Tieleman RG, Plantinga Y, Rinkes D, et al. Validation and clinical use of a novel diagnostic device for screening of atrial fibrillation. Europace 2014; 16: 1291–95.
48 Verberk WJ, Omboni S, Kollias A, Stergiou GS. Screening for atrial fibrillation with automated blood pressure measurement: research evidence and practice recommendations. Int J Cardiol 2015;203: 465–73.
49 McManus DD, Lee J, Maitas O, et al. A novel application for the detection of an irregular pulse using an iPhone 4S in patients with atrial fibrillation. Heart Rhythm 2013; 10: 315–19.
50 Levin LA, Husberg M, Sobocinski PD, et al. A cost-eff ectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke. Europace 2015; 17: 207–14.
51 Kirchhof P, Breithardt G, Bax J, et al. A roadmap to improve the quality of atrial fibrillation management: proceedings from the fi fth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference. Europace 2016; 18: 37–50.
52 Stroke Risk in Atrial Fibrillation Working Group. Independent predictors of stroke in patients with atrial fibrillation: a systematic review. Neurology 2007; 69: 546–54.
53 Banerjee A, Taillandier S, Olesen JB, et al. Ejection fraction and outcomes in patients with atrial fibrillation and heart failure: the Loire Valley Atrial Fibrillation Project. Eur J Heart Fail 2012; 14: 295–301.
54 Pisters R, Lane DA, Marin F, Camm AJ, Lip GY. Stroke and thromboembolism in atrial fibrillation. Circ J 2012; 76: 2289–304.
55 Wagstaff AJ, Overvad TF, Lip GY, Lane DA. Is female sex a risk factor for stroke and thromboembolism in patients with atrial fibrillation? A systematic review and meta-analysis. QJM 2014;107: 955–67.
56 Piccini JP, Simon DN, Steinberg BA, et al. Differences in clinical and functional outcomes of atrial fibrillation in women and men: two-year results from the ORBIT-AF registry. JAMA Cardiol 2016: 1: 282–91.
57 Chao TF, Wang KL, Liu CJ, et al. Age threshold for increased stroke risk among patients with atrial fibrillation: a nationwide cohort study from Taiwan. J Am Coll Cardiol 2015; 66: 1339–47.
58 Lip GY, Nielsen PB. Should patients with atrial fibrillation and 1 stroke risk factor (CHA2DS2-VASc score 1 in men, 2 in women) be anticoagulated? Yes: even 1 stroke risk factor confers a real risk of stroke. Circulation 2016; 133: 1498–503.
59 Nielsen P
1 Jorgensen HS, Nakayama H, Reith J, Raaschou HO, Olsen TS. Acute stroke with atrial fibrillation. The Copenhagen Stroke Study. Stroke 1996; 27: 1765–69.
2 Kimura K, Minematsu K, Yamaguchi T. Atrial f brillation as a predictive factor for severe stroke and early death in 15 831 patients with acute ischaemic stroke. J Neurol Neurosurg Psychiatry 2005; 76: 679–83.
3 Marini C, De Santis F, Sacco S, et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study. Stroke 2005; 36: 1115–19.
4 Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007; 146: 857–67.
5 Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014; 383: 955–62.
6 Mozaff arian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation 2016; 133: e38–360.
7 Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke 1991; 22: 983–88.
8 Bjorck S, Palaszewski B, Friberg L, Bergfeldt L. Atrial fibrillation, stroke risk, and warfarin therapy revisited: a population-based study. Stroke 2013; 44: 3103–08.
9 Yiin GS, Howard DP, Paul NL, et al. Recent time trends in incidence, outcome and premorbid treatment of atrial fibrillation-related stroke and other embolic vascular events: a population-based study. J Neurol Neurosurg Psychiatry 2015; published online Oct 20. DOI:10.1136/jnnp-2015-311947.
10 Leyden JM, Kleinig TJ, Newbury J, et al. Adelaide Stroke Incidence Study: declining stroke rates but many preventable cardioembolic strokes. Stroke 2013; 44: 1226–31.
11 Yiin GS, Howard DP, Paul NL, et al. Age-specific incidence, outcome, cost, and projected future burden of atrial fibrillation-related embolic vascular events: a population-based study. Circulation 2014; 130: 1236–44.
12 Friberg L, Rosenqvist M, Lindgren A, Terent A, Norrving B, Asplund K. High prevalence of atrial fibrillation among patients with ischemic stroke. Stroke 2014; 45: 2599–605.
13 Li L, Yiin GS, Geraghty OC, et al. Incidence, outcome, risk factors, and long-term prognosis of cryptogenic transient ischaemic attack and ischaemic stroke: a population-based study. Lancet Neurol 2015;14: 903–13.
14 Sanna T, Diener HC, Passman RS, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med 2014; 370: 2478–86.
15 Gladstone DJ, Spring M, Dorian P, et al. Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med 2014; 370: 2467–77.
16 Sposato LA, Cipriano LE, Saposnik G, Vargas ER, Riccio PM, Hachinski V. Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol 2015; 14: 377–87.
17 Hart RG, Diener HC, Coutts SB, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol 2014; 13: 429–38.
18 Ntaios G, Papavasileiou V, Milionis H, et al. Embolic strokes of undetermined source in the Athens Stroke Registry: an outcome analysis. Stroke 2015; 46: 2087–93.
19 Camm AJ, Lip GYH, Caterina RD, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. An update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 2012;33: 2719–47.
20 Diener HC, Easton JD, Granger CB, et al. Design of Randomized, double-blind, Evaluation in secondary Stroke Prevention comparing the Effi cacy and safety of the oral Thrombin inhibitor dabigatran etexilate vs. acetylsalicylic acid in patients with Embolic Stroke of Undetermined Source (RE-SPECT ESUS). Int J Stroke 2015;10: 1309–12.
21 Freedman B, Martinez C, Katholing A, Rietbrock S. Residual risk of stroke and death in anticaogulant-treated patients with atrial fibrillation. JAMA Cardiol 2016; 1: 366–68.
22 Lip GY, Al-Khatib SM, Cosio FG, et al. Contemporary management of atrial fibrillation: what can clinical registries tell us about stroke prevention and current therapeutic approaches? J Am Heart Assoc 2014; 3: e001179.
23 Kakkar AK, Mueller I, Bassand JP, et al. Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry. PLoS One 2013;8: e63479.
24 Gladstone DJ, Bui E, Fang J, et al. Potentially preventable strokes in high-risk patients with atrial fibrillation who are not adequately anticoagulated. Stroke 2009; 40: 235–40.
25 Sjalander S, Sjalander A, Svensson PJ, Friberg L. Atrial fibrillation patients do not benefi t from acetylsalicylic acid. Europace 2014;16: 631–38.
26 Ben Freedman S, Gersh BJ, Lip GY. Misperceptions of aspirin efficacy and safety may perpetuate anticoagulant underutilization in atrial fibrillation. Eur Heart J 2015; 36: 653–56.
27 Lip GY. The role of aspirin for stroke prevention in atrial fibrillation. Nat Rev Cardiol 2011; 8: 602–06.
28 NICE. Atrial fibrillation: management. NICE guidelines [CG180]. 2014. https://www.nice.org.uk/guidance/cg180?unlid=942923866201617111 (accessed Aug 10, 2016).
29 Ogawa S, Aonuma K, Tse HF, et al. The APHRS’s 2013 statement on antithrombotic therapy of patients with nonvalvular atrial fibrillation. J Arrhythm 2013; 29: 190–200.
30 Ben Freedman S, Lowres N. Asymptomatic atrial fibrillation: the case for screening to prevent stroke. JAMA 2015; 314: 1911–12.
31 Potter BJ, Le Lorier J. Taking the pulse of atrial fibrillation. Lancet 2015; 386: 113–15.
32 Martinez C, Katholing A, Freedman SB. Adverse prognosis of incidentally detected ambulatory atrial fibrillation. A cohort study. Thromb Haemost 2014; 112: 276–86.
33 Tsang TS, Barnes ME, Pellikka PA, et al. Silent atrial fibrillation in Olmsted county: a community-based study. Can J Cardiol 2011;27: S122.
34 Siontis KC, Gersh BJ, Killian JM, et al. Typical, atypical, andasymptomatic presentations of new-onset atrial fibrillation in the community: characteristics and prognostic implications. Heart Rhythm 2016; 13: 1418–24.
35 Boriani G, Laroche C, Diemberger I, et al. Asymptomatic atrial fibrillation: clinical correlates, management, and outcomes in the EORP-AF Pilot General Registry. Am J Med 2015; 128: 509–18.e2.
36 Healey JS, Connolly SJ, Gold MR, et al. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med 2012; 366: 120–29.
37 Glotzer TV, Hellkamp AS, Zimmerman J, et al. Atrial high rate episodes detected by pacemaker diagnostics predict death and stroke: report of the Atrial Diagnostics Ancillary Study of the Mode Selection Trial (MOST). Circulation 2003; 107: 1614–19.
38 Larsen BS, Kumarathurai P, Falkenberg J, Nielsen OW, Sajadieh A. Excessive atrial ectopy and short atrial runs increase the risk of stroke beyond incident atrial fibrillation. J Am Coll Cardiol 2015;66: 232–41.
39 Brambatti M, Connolly SJ, Gold MR, et al. Temporal relationship between subclinical atrial fibrillation and embolic events. Circulation 2014; 129: 2094–99.
40 Turakhia MP, Ziegler PD, Schmitt SK, et al. Atrial fibrillation burden and short-term risk of stroke: case-crossover analysis of continuously recorded heart rhythm from cardiac electronic implanted devices. Circ Arrhythm Electrophysiol 2015; 8: 1040–47.
41 Martin DT, Bersohn MM, Waldo AL, et al. Randomized trial of atrial arrhythmia monitoring to guide anticoagulation in patients with implanted defibrillator and cardiac resynchronization devices. Eur Heart J 2015; 36: 1660–68.
42 Kamel H, Okin PM, Elkind MS, Iadecola C. Atrial fibrillation and mechanisms of stroke: time for a new model. Stroke 2016;47: 895–900.
43 Lowres N, Neubeck L, Redfern J, Freedman SB. Screening to identify unknown atrial fibrillation. A systematic review. Thromb Haemost 2013; 110: 213–22.
44 Svennberg E, Engdahl J, Al-Khalili F, Friberg L, Frykman V, Rosenqvist M. Mass screening for untreated atrial fibrillation: the STROKESTOP study. Circulation 2015; 131: 2176–84.
45 Fitzmaurice DA, Hobbs FDR, Jowett S, et al. Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial. BMJ 2007; 335: 383.
46 Lowres N, Neubeck L, Salkeld G, et al. Feasibility and cost-eff ectiveness of stroke prevention through community screening for atrial fibrillation using iPhone ECG in pharmacies. The SEARCH-AF study. Thromb Haemost 2014; 111: 1167–76.
47 Tieleman RG, Plantinga Y, Rinkes D, et al. Validation and clinical use of a novel diagnostic device for screening of atrial fibrillation. Europace 2014; 16: 1291–95.
48 Verberk WJ, Omboni S, Kollias A, Stergiou GS. Screening for atrial fibrillation with automated blood pressure measurement: research evidence and practice recommendations. Int J Cardiol 2015;203: 465–73.
49 McManus DD, Lee J, Maitas O, et al. A novel application for the detection of an irregular pulse using an iPhone 4S in patients with atrial fibrillation. Heart Rhythm 2013; 10: 315–19.
50 Levin LA, Husberg M, Sobocinski PD, et al. A cost-eff ectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke. Europace 2015; 17: 207–14.
51 Kirchhof P, Breithardt G, Bax J, et al. A roadmap to improve the quality of atrial fibrillation management: proceedings from the fi fth Atrial Fibrillation Network/European Heart Rhythm Association consensus conference. Europace 2016; 18: 37–50.
52 Stroke Risk in Atrial Fibrillation Working Group. Independent predictors of stroke in patients with atrial fibrillation: a systematic review. Neurology 2007; 69: 546–54.
53 Banerjee A, Taillandier S, Olesen JB, et al. Ejection fraction and outcomes in patients with atrial fibrillation and heart failure: the Loire Valley Atrial Fibrillation Project. Eur J Heart Fail 2012; 14: 295–301.
54 Pisters R, Lane DA, Marin F, Camm AJ, Lip GY. Stroke and thromboembolism in atrial fibrillation. Circ J 2012; 76: 2289–304.
55 Wagstaff AJ, Overvad TF, Lip GY, Lane DA. Is female sex a risk factor for stroke and thromboembolism in patients with atrial fibrillation? A systematic review and meta-analysis. QJM 2014;107: 955–67.
56 Piccini JP, Simon DN, Steinberg BA, et al. Differences in clinical and functional outcomes of atrial fibrillation in women and men: two-year results from the ORBIT-AF registry. JAMA Cardiol 2016: 1: 282–91.
57 Chao TF, Wang KL, Liu CJ, et al. Age threshold for increased stroke risk among patients with atrial fibrillation: a nationwide cohort study from Taiwan. J Am Coll Cardiol 2015; 66: 1339–47.
58 Lip GY, Nielsen PB. Should patients with atrial fibrillation and 1 stroke risk factor (CHA2DS2-VASc score 1 in men, 2 in women) be anticoagulated? Yes: even 1 stroke risk factor confers a real risk of stroke. Circulation 2016; 133: 1498–503.
59 Nielsen P
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