Antithrombotic treatment of permanent atrial fibrillation

: Whether idiopathic or associated with an underlying heart disease, complete arrhythmia induced by atrial fibrillation ranks first among the causes of arterial embolism. It has been recognized that 30 to 35% of subjects with arrhythmia develop a transient or permanent ischaemic cerebral accident, and it is therefore rational to assess the value of systematic antithrombotic treatment in the prevention of such accidents. It is agreed by all that anticoagulants are necessary when atrial fibrillation occurs in the course of cardiac valve diseases, notably those of rheumatismal origin. Conversely, the idiopathic complete arrhythmia, which usually occurs in subjects aged below 60, calls for either therapeutic abstention or prescription of antiplatelet drugs. In all other cases, five randomized trials can be used as reference. They all show that thromboembolic accidents and mortality can be reduced and favour a systematic preventive treatment. The risk of haemorrhage has been diversely evaluated in these five trials. The choice between anticoagulant and antiplatelet therapies therefore rests on a case by case analysis aimed at balancing in each patient the benefits expected against the possible risks.