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~ 138,330 cardioembolic2
~ 50%
Ventricular thrombus
15%
50%
Valvular heart disease
20%
Structural heart defects or tumors
70 67.3
5
60
HR for event
50 N=1084 4 N=90,490
44.2
40.8
40 2.96
3
28.5
30 23.5
17.3 2
20 1.19 1.19 1.21
9.1 0.98 1.07
10 1
0
0
Blood stasis
To carotid artery
Cardioembolic clot3
MCA
PCA
LAD artery
(proximal)4
Femoral
artery5
ACA territory
MCA territory
PCA territory
80
67.9
59.9 AFib (n=6842)
60 50 No AFib (n=20,118)
40.4
40
14.3 17.3
20 11.8 12.3
0
Hemiplegia Speech disturbances Visual disturbances Dysphagia
Per Second Per Minute Per Hour Per Stroke (~10 hr)
50
45 43.1
Proportion of patients (%)
40
35
AFib (n=6842) 30.8
30
25 No AFib (n=20,118)
20
14.6 14.7
15 11.6 11.4
10.5
10 8.4 7.5
5.9
5
0
Mechanical Pneumonia Urinary Urinary tract Any complication
vent/ICU/coma incontinence infection
(p<0.0001) (p<0.0001) (p<0.0001) (p<0.0001) (p<0.0001)
60
50 44 AFib 45.1
40
No
30 AFib
20
10
0
†
Steger et al (n=992)* Kimura et al (n=15,831)
*Patients with AFib were older, more likely to be female, have a history of stroke, CAD, and heart disease. 1
†Patients with AFib were older, more likely to be female, and have a history of stroke. 4
14.1 14.7
15 30
10.9
10 20
5 10
0 0
30 day 90 day 1 year 1 2 3 4 5 6 7 8
Years
1. Gattellari M et al. Cerebrovasc Dis. 2011;32:370-382.
2. Marini C et al. Stroke. 2005;36:1115-1119.
Patients With Atrial Fibrillation-Related Ischemic
Stroke Are More Likely to Remain Disabled
70 64.3
58.6
60
49.7
50 46.1
40
29.6
30
AFib (n=30)
20 No AFib (n=120)
10
0
Acute 3 months 6 months 12 months
Phase 1 – Stroke
Phase 2 – Expectations for Recovery Phase 3 – Crisis of Discharge
Crisis
Family Caregivers
Increasing focus on & responsibility for patient’s needs
Medium-term
Population 33% (0% to 72%)
Hospital 32% (23% to 41%)
Rehabilitation 36% (20% to 39%)
Subtotal 34% (20% to 39%)
Long-term
Population 34% (24% to 43%)
Hospital 34% (24% to 45%)
Rehabilitation 34% (26% to 42%)
Subtotal 34% (29% to 39%)
0 20 40 60 80 100
Percent
• As many as 1 in 3 stroke patients will report symptoms of depression, regardless of stroke etiology
10
5
8 (p= NS)
4
3 6
2 4
(p= NS)
1 2
0 0
Rate Rhythm Low-Risk* Moderate-Risk† High-Risk‡
*No moderate or high-risk features.
†Hypertension (systolic BP > 160 mm Hg or diastolic BP > 90 mm Hg) and age ≤ 75 years; diabetes (definition not indicated),
*48,599 patients with AFib on anticoagulation, does not include patients on anticoagulation + aspirin
1. Pisters R et al. CHEST. 2010;138:1093-1100.
2. Friberg L et al. Eur Heart J. 2012;33:1500-1510.
Anticoagulation Is Recommended to Reduce
the Risk of Ischemic Stroke and Systemic
Thromboembolism
• ACCF/AHA/HRS Guidelines for Antithrombotic Therapy for Patients With AFib1*
• For primary prevention of thromboembolism in patients with NVAF
• Antithrombotic therapy with either aspirin or an anticoagulant is reasonable in
patients with one moderate risk factor
• Antithrombotic therapy is recommended for patients with more than 1
moderate risk factor
• Anticoagulation is associated with an increased risk of bleeding, including hemorrhagic
stroke. This risk must be weighed against the benefit of stroke risk reduction2,3
• Anticoagulation therapy has been shown to reduce the risk of ischemic stroke up to 2/3
(67%) vs control/placebo4
ACCF=American College of Cardiology Foundation; AHA=American Heart Association; HRS=Heart Rhythm Society
*The American Heart Association is a voluntary national health agency to help reduce disability and death from cardiovascular
disease and stroke. The full guidelines can be located online at: http://circ.ahajournals.org/content/123/10/e269.
High-risk factors: prior thromboembolism (stroke, TIA, or systemic embolism) and mitral stenosis, prosthetic heart valve.1
Moderate-risk factors: age ≥75 years, hypertension, heart failure, LVEF ≤ 35%, and diabetes mellitus.1
Less validated risk factors: female gender, age 65-74 years, coronary artery disease, thyrotoxicosis.1
65 64
55 54 52
51
50
41
0
ATRIA1 NABOR2 Hylek3 Medicare4 Walker5 Williams6 Euro
N= 11,082 N= 945 N= 405 N= 17,272 N= 116,969 N= 50,071 Heart Study7
N= 2706
ATRIA= Anticoagulation and Risk Factors in Atrial Fibrillation.
NABOR= National Anticoagulation Benchmark and Outcomes Report.
1. Go AS et al. Ann Intern Med. 1999;131:927-934. 2. Waldo AL et al. J Am Coll Cardiol. 2005;46:1729-1736. 3. Hylek EM et al. Stroke. 2006;37:1075-1080.
4. Birman-Deych E et al. Stroke. 2006;37:1070-1074. 5. Walker AM, Bennett D. Heart Rhythm. 2008;5:1365-1372. 6. Williams CJ et al. American College of
Cardiology 58th Annual Scientific Session; March 29-31, 2009; Orlando, FL. 7. Nieuwlaat R et al. Eur Heart J. 2006;27:3018-3026.
Conclusions
AFIB574903PROF