Rational Pharmacotherapy in Cardiology

Advanced search


Full Text:


Appropriate use of warfarin is not in routine clinical practice despite convincing data of clinical studies on the possibility of effective reduction in frequency of thromboembolic complications associated with nonvalvular atrial fibrillation, particularly ischemic stroke. Confirmation of the efficacy and implementation of measures related to the effect on blood clotting and providing basically new possibilities to reduce the risk of ischemic events expected in the near future.

About the Authors

A. Y. Rychkov
Branch of the Research Institute of Cardiology of the Siberian branch of the Russian Academy of Medical Science “Tyumen Cardiology Center”
Russian Federation
Melnikaite ul. 111, Tyumen, 625026

N. Y. Khor'kova
Branch of the Research Institute of Cardiology of the Siberian branch of the Russian Academy of Medical Science “Tyumen Cardiology Center”
Russian Federation
Melnikaite ul. 111, Tyumen, 625026

A. A. Bliznyakov
Branch of the Research Institute of Cardiology of the Siberian branch of the Russian Academy of Medical Science “Tyumen Cardiology Center”
Russian Federation
Melnikaite ul. 111, Tyumen, 625026


1. Petersen P., Boysen G., Godfredsen J. et al. Placebo-controlled,randomised trial of warfarin and aspirin for the prevention of thromboembolic complications in chronic atrial fibrillation. The Copenhagen AFASAK study. Lancet 1989; 1(8631): 175-179.

2. Gattellari M., Worthington J., Zwar N. Warfarin: An Inconvenient Truth. Stroke 2009; 40(1): 5-7.

3. Hart R.G., Pearce L.A., Aguilar M.I. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007; 146(12): 857–867.

4. Fuster V., Rydén L.E., Asinger R.W. et al. ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee toDevelop Guidelines forthe Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology. Circulation 2001;104 (17): 2118-50.

5. Диагностика и лечение фибрилляции предсердий. Рекомендации ВНОК. В Оганов Р.Г., Мамедов М.Н., редакторы. Национальные кли- нические рекомендации. М.: МЕДИ-Экспо: 2009. С. 347-372.

6. Антитромботическая терапия у больных со стабильными проявлениями атеротромбоза. Российские рекомендации. Кардиоваскулярная терапия и профилактика 2009; 8 (6): 1-20.

7. Wang Y.L., Wu D., Nguyen-Huynh M.N. et al. Antithrombotic management ofischemic stroke and transientischemic attack in China:Aconsecutive cross-sectional survey. Clin Exp Pharmacol Physiol 2010; 37(8):775-81.

8. Murphy N.F., Simpson C.R.,Jhund P.S. et al.Anational survey ofthe prevalence, incidence, primary care burden and treatment of atrial fibrillation in Scotland. Heart 2007; 93(5): 606-12.

9. Hansen M.L., Gadsboll N., Gislason G.H. et al. Atrial Fibrillation Pharmacotherapy AfterHospitalDischarge Between 1995 and 2004: A Shift Towards Beta-Blockers. Europace 2008; 10(4): 395-402.

10. Allen LaPointe N.M., Governale L., Watkins J. et al. Outpatient use of anticoagulants, rate-controlling drugs, and antiarrhythmic drugs for atrial fibrillation. Am Heart J 2007; 154(5): 893-8.

11. Scott P.A., Pancioli A.M., Davis L.A. et al. Prevalence of Atrial Fibrillation andAntithrombotic Prophylaxis in EmergencyDepartment Patients. Stroke 2002; 33(11): 2664-2669.

12. Friberg L., Hammar N., Ringh M. et al. Stroke prophylaxis in atrial fibrillation: who gets it and who does not? Reportfrom the Stockholm Cohort-study onAtrial Fibrillation (SCAF-study). EurHeartJ 2006; 27(16): 1954-64.

13. Choudhry N.K., Soumerai S.B., Normand S.L. et al. Warfarin prescribing in atrial fibrillation: the impact of physician, patient, and hospital characteristics. Am J Med 2006; 119(7): 607-15.

14. DeWilde S., Carey I.M., Emmas C. et al. Trends in the prevalence of diagnosed atrial fibrillation, its treatment with anticoagulation and predictors of such treatmentin UK primary care.Heart 2006; 92(8): 1064- 70.

15. Bo S., Valpreda1 S., Scaglione L. et al. Implementing hospital guidelines improves warfarin use in non-valvular atrial fibrillation: a before￾after study. BMC Public Health 2007; 7: 203-212.

16. Boulanger L., Kim J., Friedman M. et al. Patterns of use of antithrombotic therapy and quality of anticoagulation among patients with nonvalvular atrial fibrillation in clinical practice. IntJ Clin Pract 2006; 60(3): 258-64.

17. Gladstone D.J., Bui E., Fang J. et al. Potentially Preventable Strokes in High-Risk Patients With Atrial Fibrillation Who Are Not Adequately Anticoagulated. Stroke 2009; 40(1): 235-240.

18. Nabauer M., Gerth A., Limbourg T. et al. The Registry of the German Competence NETwork on Atrial Fibrillation: patient characteristics and initial management. Europace 2009; 11(4): 423–434.

19. Nieuwlaat R., Capucci A., Camm A.J. et al. Atrial fibrillation management: a prospective survey in ESC member countries: the Euro Heart Survey on Atrial Fibrillation. Eur Heart J 2005; 26(22): 2422–34.

20. Kowey P.R., Reiffel J.A., Myerburg R. et al. Warfarin and aspirin use in atrial fibrillation among practicing cardiologist (from the AFFECTS Registry). Am J Cardiol 2010; 105(8): 1130-4.

21. Hylek E.M., Skates S.J., Sheehan M.A., Singer D.E. An Analysis of the Lowest Effective Intensity of Prophylactic Anticoagulation for Patients with NonrheumaticAtrial Fibrillation. N EnglJ Med 1996; 335 (8): 540- 546.

22. Hylek E.M., Go A.S., Chang Y. et al. Effect of Intensity of Oral Anticoagulation on Stroke Severity and Mortality in Atrial Fibrillation. N Engl J Med 2003; 349(11): 1019-1026.

23. Schwammenthal Y., Bornstein N., Schwammenthal E. et al. Relation of effective anticoagulation in patients with atrialfibrillation to stroke severity and survival (from the National Acute Stroke Israeli Survey [NASIS]). Am J Cardiol 2010; 105(3): 411-6.

24. Kucher N., Connolly S., Beckman J.A. et al. International Normalized Ratio Increase Before Warfarin-Associated Hemorrhage. Arch Intern Med 2004; 164(19): 2176-2179.

25. Baker W.L., Cios D.A., Sander S.D., Coleman C.I. Meta-analysis to assess the quality of warfarin control in atrial fibrillation patients in the United States. J Manag Care Pharm 2009; 15(3): 244-52.

26. WhiteH.D., Gruber M., FeyziJ. et al. Comparison of Outcomes Among Patients Randomized to Warfarin Therapy According to Anticoagulant Control. Results From SPORTIF III andV.Arch Intern Med 2007; 167(3): 239-245

27. WanY., Heneghan C., Perera R. et al. Anticoagulation Control and Prediction ofAdverse Events in Patients WithAtrial Fibrillation.ASystematic Review. Circ Cardiovasc Qual Outcomes 2008; 1(2): 84-91.

28. Kim J.H., Song Y.B., Shin D.H. et al. How Well Does the Target INR Level Maintain in Warfarin-Treated Patients with Non-ValvularAtrial Fibrillation? Yonsei Med J 2009; 50(1): 83 – 88.

29. Samsa G.P., Matchar D.B., Goldstein L.B. et al. Quality of Anticoagulation Management Among Patients With Atrial Fibrillation. Results of a Review of Medical Records From 2 Communities. Arch Intern Med 2000; 160(7): 967-973.

30. Sarawate C., Sikirica M.V., Willey V.J. et al. Monitoring anticoagulation in atrial fibrillation. J Thromb Thrombolysis 2006; 21(2): 191-8.

31. Burton C., Isles C., Norrie J. et al. The safety and adequacy of antithrombotic therapy for atrial fibrillation: a regional cohort study. Br J Gen Pract 2006; 56(530): 697-702.

32. Usman M.H., Notaro L.A., PatelH., Ezekowitz M.D. New developments in anticoagulation for atrial fibrillation. Curr Treat Options Cardiovasc Med 2008; 10(5): 388-97.

33. Connolly S.J., Ezekowitz M.D., Yusuf S. et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361(12): 1139-1151.

34. Turpie A.G. Oral, Direct Factor Xa Inhibitors inDevelopment forthe Prevention and Treatment of Thromboembolic Diseases. Arterioscler Thromb Vasc Biol 2007; 27(6):1238-1247.

35. Sobieraj-Teague M., O'Donnell M., Eikelboom J. New anticoagulants for atrial fibrillation. Semin Thromb Hemost 2009; 35(5): 515-24.

36. Piccini J.P., Lopes R.D., Mahaffey K.W. Oral factor Xa inhibitors for the prevention of stroke in atrialfibrillation. Curr Opin Cardiol 2010; 25(4): 312-20.

37. Лякишев А.А. Сравнение дабигатрана и варфарина у больных с мерцательной аритмией. Кардиология 2009; 10: 75-76.

38. Khoo C.W., Lip G.Y. Insights from the dabigatran versus warfarin in patientswith atrialfibrillation (RE-LY) trial. Expert Opin Pharmacother2010; 11(4): 685-7.

39. Rother J., Laufs U. Pravention des Schlaganfalls durch Behandlung des Vorhofflimmerns Neue Hoffnung durch Dronedaron und Dabigatran? Dtsch Med Wochenschr 2010; 135 Suppl 2: S55-8.

40. Connolly S., Pogue J., Hart R. et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events (ACTIVE W): a randomised controlled trial. Lancet 2006; 367(9526): 1903-1912.

41. Hohnloser S.H., Pajitnev D., Pogue J. et al. Incidence of Stroke in Paroxysmal Versus Sustained Atrial Fibrillation in Patients Taking Oral Anti￾coagulation or CombinedAntiplatelet Therapy.AnACTIVE W Substudy. J Am Coll Cardiol 2007; 50(22): 2156–61.

42. The ACTIVE Investigators. Effect of clopidogrel added to aspirin in patients with atrialfibrillation. N EnglJ Med 2009; 360(20): 2066-2078.

43. Go AS. The ACTIVE Pursuit of Stroke Prevention in Patients with Atrial Fibrillation. N Engl J Med 2009; 360(20): 2127-2129.

44. Manning W.J., Weintraub R.M., Waksmonski C.A. et al. Accuracy of transesophageal echocardiography for identifying left atrial thrombi: a prospective, intraoperative study. Ann Intern Med 1995; 123(11): 817-822.

45. Holmes D.R., Reddy V.Y., Turi Z.G. et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: A randomised non-inferiority trial. Lancet 2009; 374(9689): 534-542.

46. Leithauser B., Park J.W. Cardioembolic stroke in atrialfibrillation-rationale for preventive closure of the left atrial appendage. Korean Circ J 2009; 39(11): 443-458.

47. Cruz-Gonzalez I., Yan B.P., Lam Y.Y. Left atrial appendage exclusion: state-of-the-art. Catheter Cardiovasc Interv 2010; 75(5): 806-813.

For citation:

Rychkov A.Y., Khor'kova N.Y., Bliznyakov A.A. ANTITHROMBOTIC THERAPY IN NONVALVULAR ATRIAL FIBRILLATION: PROBLEMS AND PROSPECTS. Rational Pharmacotherapy in Cardiology. 2010;6(4):522-527. (In Russ.)

Views: 306

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)