老年人非瓣膜病心房颤动患者华法林5mg起始治疗的有效性及安全性

目的探讨老年人非瓣膜病心房颤动(NVAF)患者应用华法林5 mg起始治疗的疗效及安全性。方法入选具有华法林抗凝适应证的NVAF老年患者91例,随机分为2组,分别以5 mg/d或3 mg/d起始治疗,于治疗前、治疗后第3、4、5、8天测定国际标准化比值(INR),根据INR调整服药剂量,至INR稳定。结果 5 mg/d起始治疗第3、4、5、8天INR的达标率分别为3.9%、29.4%、43.1%和72.5%,INR达稳定时间为(9.8±2.3)d,与3 mg/d组0%、5%、22.5%、50%[(12.5±2.7)d]比较,差异有统计学意义(均P<0.05),出血发生率两组差异无统计学意义。结论 5 mg/d起始,连续4 d的华法林起始治疗方案能使INR迅速、安全、有效地达到稳定,无严重出血并发症发生。     

华法林对非瓣膜病心房颤动抗栓的安全性和有效性研究

目的观察华法林对非瓣膜病心房颤动(房颤)患者抗凝治疗的有效性和安全性。方法在18个中心进行阿司匹林(150～160 mg/d)与调整剂量华法林组随机对照研究中选取患者。华法林初始剂量2 mg/d,目标国际标准化比值(INR)2.0～3.0(年龄≥75岁者为1.6～2.5),常规门诊随访,分析该组患者终点事件和出血事件的发生及与抗凝强度的关系。结果共335例患者随机服用华法林,男204例(60.9%),年龄(62.6±10.3)岁,随访2～24个月(中位数19个月)。华法林平均剂量(3.19±0.69)mg。共进行 INR 测定3482人次,其中2378次 INR(占68.3%)维持2.0～3.0。用药期间发生主要终点事件10例(2.7%),次要终点事件19例(5.7%)。服用华法林期间总出血发生率为23例(6.9%),其中严重出血5例(1.5%),轻微出血18例(5.4%);发生血栓栓塞事件(缺血性卒中及体循环栓塞)19例(5.4%),其中15例(4.5%)患者发生事件时的 INR<2.0。多因素 logistic 回归显示,抗凝出血和血栓栓塞事件的独立危险因素均为年龄>75岁,前者收缩压≥160mm Hg,血肌酐升高,INR>3.0;后者有卒中病史,左室射血分数<0.40%和 INR<2.0。结论中国人非瓣膜病房颤患者应用华法林抗凝 INR 维持在2.0～3.0是安全有效的,但应避免 INR>3.0,以最大限度减少出血并发症,尤其应严密监测高龄、合并心力衰竭和肾功能异常的患者。     

心房颤动病人华法林抗凝治疗安全性评价

目的评价华法林用于心房颤动(房颤)病人抗凝治疗的安全性.方法选择符合本研究标准的42例房颤病人随机分为2组华法林治疗组(治疗组)23例,给予华法林,自3mg/d开始口服,用药第1周隔日测国际标准化比值(INR),1周后若INR未达到2.0～3.0,增加华法林至4mg/d,每隔1周测INR,使其达到2.0～3.0之间,4周后每月测INR 1次,若病人增加或减少某种药物时,随时再测INR,根据INR调整华法林剂量.阿司匹林对照组(对照组)19例,给予阿司匹林200mg/d,分2次口服,每月复查大便潜血1次.结果治疗组病人10～14(平均11.1±2.2)天INR达2.0～3.0(平均2.35±0.11),有1例病人在华法林3mg/d口服3个月后出现消化道出血,当时INR为2.15,胃镜检查诊断为"胃溃疡".对照组2例病人出现上腹部烧灼感.2组总不良反应发生率,差异无显著性.2组病人均无血栓栓塞事件发生.结论在华法林治疗4周内及改变其它药物时加强INR监测,随时调整华法林剂量,使INR保持在2.0～3.0之间,病人和医师保持密切联系,华法林在房颤病人中的使用是安全的.     

城郊高龄老年房颤患者华法林治疗的安全性

目的：探讨城郊高龄老年房颤患者应用华法林的安全性.方法：选择100例资料完整的老年房颤患者,按照数字表法,被随机分为华法林组（51例）：华法林起始剂量1.25 mg,1次/d.每隔3d测定血浆凝血酶原时间国际标准化比值（INR）1次.2～4周达到目标范围,如INR未达标,每隔1周增加华法林0.625 mg,直到INR控制在2.0～3.0.INR稳定前门诊随访每周监测1次,INR稳定后每4周监测1次;阿司匹林组（49例）：阿司匹林,100 mg,1次/d.结果：与阿司匹林组比较,华法林组血栓栓塞等终点事件发生率明显降低（19.15％比3.92％,P=0.017）,出血等不良反应发生率无显著差异（4.25％比5.88％,P＞0.05）.结论：高龄老年房颤患者应用华法林,能显著降低栓塞发生率,而且是安全的.     

高龄非瓣膜病性房颤患者长期应用华法林抗凝治疗的疗效与安全性

目的观察高龄非瓣膜病性房颤(NVAF)患者长期应用华法林抗凝治疗的疗效及安全性。方法入选NVAF患者按年龄分为3组,高龄老年组55例,年龄≥80岁(INR在1.6~2.5之间);老年组45例,年龄65~79岁(INR在l.6~2.5之间);中年组37例,年龄65岁(INR在2.0~3.0)。入选患者长期服用华法林抗凝治疗,根据INR测定值及其变化趋势来调整华法林剂量,使INR达标,比较3组患者口服华法林5年时的不良反应及华法林的安全用药范围及国际标准化比值(INR)。结果 5年随访期间,三组患者均未发生缺血性卒中,三组患者出血及其他不良反应无统计学差异(P0.05)。随访第5年时,高龄老年组华法林组剂量(2.89±0.52)mg,INR(2.15±0.31),老年华法林组剂量(2.99±0.41)mg,INR(2.21±0.30),差异无统计学意义(P0.05)。中年组华法林剂量(3.39±0.61)mg,INR(2.55±0.60),华法林剂量及INR明显高于高龄老年组和老年组,差异有统计学意义(P0.05)。结论严密监测INR下,对于高龄老年NVAF患者应用华法林抗凝治疗,INR控制在1.5~2.5安全有效。     

非瓣膜病房颤的华法林抗凝治疗研究

目的：应用华法林对非瓣膜病性心房颤动患者进行抗凝治疗,观察其抗栓疗效和安全性。方法：服用华法林．从3．0mg。1次／d开始．根据血浆凝血酶原时间国际标准化比率（INR）调整华法林剂量．低抗凝强度组患者（46例）INR为1．5～2．1．标准抗凝强度组患者（66例）INR为2．2～3．0．两组均持续服药,随访1～4年．观察有无血栓栓塞事件及出血并发症。结果：低抗凝强度组中有1例发生脑栓塞,当时INR为1．5．栓塞年发生率为2．2％;标准抗凝强度组无栓塞并发症．两组比较差异无显著性（P〉0．05）。服用华法林期间．低抗凝强度组1例肉眼血尿,出血年发生率为2．2％;标准抗凝强度组发生皮肤黏膜出血4例．牙龈出血3例,球结膜出血1例．出血年发生率为12％。当时的INR除3例为〉3．其余均在2．6～3．0之间,未发生严重大出血．低抗凝强度组出血发生率显著低于标准抗凝血组（P〈0．05）。结论：房颤患者华法林抗凝目标INR值在1．5-3．0安全有效。     

应用受试者工作曲线确定国际标准化比率诊断非瓣膜心房颤动患者华法林抗凝出血的最佳临界值

目的 使用受试者工作曲线(ROC曲线)法,评价非瓣膜性心房颤动(房颤)患者在华法林抗凝治疗中国际标准化比率(INR)对出血事件的预测和诊断价值,确定INR预测出血事件的最佳临界值. 方法 通过回顾性分析,选择华法林抗凝治疗的非瓣膜房颤患者231例,发生出血事件患者93例(出血组),未有出血患者138例(未出血组)作为对照.采用Sysmex CA-500检测仪检测凝血酶原时间(PT)和INR,用Medcalc软件绘制ROC曲线. 结果 其ROC曲线下面积(AUC%)为0.822,95%CI为0.717～0.900,最佳临界值为2.71,敏感性为77.40%,特异性为78.30%. 结论 通过ROC曲线评价,INR对华法林引起的出血事件预测价值较好,当患者INR值≥2.71时,出血风险明显增大,应警惕有出血风险.因此可以通过INR切值来区别服用华法林患者是否容易有出血倾向,可以指导临床内科医生预测发生出血事件的危险性,并指导临床医生用药.     

老年非瓣膜性房颤患者华法林抗凝强度的研究进展

流行病学调查显示房颤的发病率逐年上升,尤其在老年人中,年龄越大,其发病率和死亡率越高。多个临床试验显示,目前华法林仍是治疗房颤的主要药物。欧美国家的房颤指南建议将国际标准化比值(INR)控制在2.0～3.0,但亚洲和欧美人群之间存在种族差异,应适当降低华法林抗凝强度,尤其是对于有高卒中、高出血风险的老年非瓣膜性房颤(NVAF)患者,INR控制在1.5～2.5是安全有效的,但这一结论仍缺乏大量的临床试验及循证医学依据。     

老年心房颤动病人华法林抗凝治疗的有效性安全性评价

目的　评价华法林用于老年心房颤动病人抗凝治疗的有效性、安全性。方法　选择符合本研究抗凝标准的132例老年心房颤动病人随机分为两组 ,华法林治疗组 (治疗组 ) 5 8例 ,给予华法林 3mg/ d开始 ,监测凝血酶原时间(PT)及国际标准化比值 (INR) ,7～ 15 d使 INR达到 1.8～ 2 .5范围内 ,以后每月查 1次 INR。若病人增加或减少药物有出血倾向时随时再测 INR。阿司匹林对照组 (对照组 ) 74例 ,给予阿司匹林 30 0 mg/ d,分 2次口服 ,密切随访。结果　治疗组 7～ 15 d,平均 (9.1± 2 .8) d,INR达 1.8～ 3.0 (平均 2 .1± 0 .13) ,其中 INR在 1.8～ 2 .5 (平均 1.92±0 .2 3)之间者占 92 .7% ,治疗组有 1例心瓣膜病人出现脑梗死 ,而对照组有 7例发生脑梗死 ,差异显著 ,其余不良反应率两组差异无显著性。结论　老年心房颤动病人选择华法林 2～ 3mg/ d时 ,加强服药后监测及各药物间的相互作用 ,使 INR保持在 1.8～ 2 .5之间是有效、安全的     

不同抗凝强度华法林对80岁及以上心房颤动患者的安全性研究

目的 探讨80岁及以上非瓣膜性心房颤动(房颤)患者使用不同抗凝强度华法林的安全性.方法 130例老年持续性或永久性房颤患者被随机抽签分为3组:(1)低强度抗凝组国际标准化比率(INR)1.5～2.0;(2)中等强度抗凝组INR 2.1～2.5;(3)阿司匹林组.观察3组的出血事件情况及对肾功能的影响.结果 低强度抗凝组(35例)无致命性出血及严重出血,轻微出血2例(5.7%);中等强度抗凝组(32例)致命性出血及严重出血各1例(3.1%),轻微出血4例(12.5%);阿司匹林组(63例)致命性出血3例(4.8%),严重出血3例(4.8%),轻微出血7例(11.1%).3组总出血率比较,差异有统计学意义(χ2=5.13,P＜0.05).低强度抗凝组与中等强度抗凝组对肾功能的影响差异无统计学意义(P＞0.05),但两组明显优于阿司匹林组(P＜0.05).结论 80岁及以上房颤患者中,华法林抗凝INR值维持在1.5～2.0安全性好,对肾功能影响较阿司匹林轻.

Abstract：

Objective To investigate the safety of different intensity anticoagulation therapy of warfarin in preventing thromboembolism in octogenarian patients with nonvalvular atrial fibrillation (NVAF). Methods The 130 patients with persistent or permanent NVAF were randomly divided into three groups: low-intensity warfarin group (35 cases, international normalized ratio, INR (1.5-2.0), moderate-intensity warfarin group (32 cases, INR 2.1-2.5) and aspirin control group (63 cases). The rate of hemorrhagic events and the effect on renal function were observed. Results The incidence of hemorrhage was the lowest in low-intensity warfarin group compared to the other groups with slight bleeding in one case. life-threatening bleeding in one case, severe bleeding in one case and slight bleeding in four cases occurred in moderate-intensity warfarin group. Life-threatening bleeding in three cases, severe bleeding in two cases and slight bleeding in six cases occurred in aspirin control group. There were significant differences in bleeding incidence among the three groups (χ2=5.13,P＜0.05). The low-intensity warfarin group and moderate-intensity warfarin group were superior to the aspirin control group in the effect on renal function (P＜0.05). Conclusions It is safe that the dose of warfarin is maintained at low anticoagulation intensity between INR 1.5 and 2.0 in octogenarians with NVAF.     

Wide variation in thrombin generation in patients with atrial fibrillation and therapeutic International Normalized Ratio is not due to inflammation

Atrial fibrillation (AF) is a common cardiac arrhythmia with a 5–20% annual risk of stroke. Warfarin reduces this risk by at least 60%. Despite adequate anticoagulation within the target International Normalized Ratio (INR) range of 2·0–3·0, some patients still experience thrombotic and bleeding events. It is now possible to assess the intensity of anticoagulation with automated thrombin generation (TG) tests, such as the calibrated automated thrombogram (CAT). These tests were compared and an inverse relationship was found between the INR and CAT in 143 elderly AF patients. There was equally good correlation between the concentration of factors II, VII, IX and X and the INR and TG parameters. The peak thrombin was most strongly associated with the concentration of prothrombin fragment 1 + 2 in plasma. There was wide variability in TG parameters in patients with identical INR values, sometimes up to a fourfold difference. This TG variability in individuals with the same INR is not due to inflammation, at least when the latter is measured as the concentration of factor VIII coagulant activity, von Willebrand factor antigen, high sensitivity C-reactive protein and fibrinogen. It was concluded that, although the TG and INR were closely correlated there was wide variability in peak thrombin and endogenous thrombin potential in patients within the INR therapeutic range, the cause of which remains unclear.     

A warfarin induction regimen for out-patient anticoagulation in patients with atrial fibrillation

Currently available protocols for induction of warfarin anticoagulation employ initial doses of 10 mg and are best suited to in-patient use. However, with the increasing number of elderly patients with atrial fibrillation requiring anticoagulation, there is a need for a less intense regimen which could be used for out-patients. We have established such a regimen and report on its prospective evaluation in 37 patients referred for out-patient initiation of warfarin, and a non-randomized comparison with 37 in-patients, with similar diagnoses, commenced on a traditional warfarin protocol. After exclusion of five patients on amiodarone, all of whom experienced supratherapeutic International Normalized Ratio (INR) results, the new out-patient regimen, employing an initial 5 mg dose, resulted in a lower maximum INR during the first 21 d therapy (median 2.9 v 4.0; P  = 0.0001) and fewer INRs > 4.5 (2/36 v 9/33) compared to the traditional 10 mg regimen. Time to reach stable anticoagulation was similar with each regimen; however, the 5 mg regimen gave a more accurate prediction of maintenance dose (correlation coefficient for predicted versus actual maintenance dose, r  = 0.985). In comparison to a traditional 10 mg protocol, the proposed 5 mg warfarin induction regimen proved both safer and more reliable for initiation of prophylactic anticoagulation in patients with atrial fibrillation.     

Complications of warfarin therapy monitored by the international normalized ratio versus the prothrombin time ratio

The objective of our study was to determine the rates of bleeding complications and thromboembolic events in patients receiving oral anticoagulant therapy monitored with the prothrombin time (PT) ratio versus therapy monitored with the International Normalized Ratio (INR) using a retrospective time-series study design. Over 650 patients enrolled in a large anticoagulation clinic were studied during two time periods corresponding to the use of the PT ratio versus the INR to guide anticoagulant therapy, with over 400 patient-years of follow-up for each time period. The rate of bleeding complications using the PT ratio to guide therapy was 6.7% (1.2% major, 5.5% minor) per patient-year, compared with 2.9% (0% major, 2.9% minor) using the INR (p = 0.02). The rate of thromboembolic complications was 1.0% using the PT ratio, compared with 0.2% using the INR (p = NS). Therapy monitored with the INR required 19.8 visits per year, compared with 20.7 visits per year using the PT ratio. We conclude that the INR should be used to monitor oral anticoagulant therapy in an effort to reduce bleeding complications while maintaining an acceptable rate of thromboembolic events.     

Adequacy of anticoagulation in patients with atrial fibrillation: effect of various parameters

BACKGROUND: Despite reported evidence of the vital importance of appropriate anticoagulation in patients with chronic atrial fibrillation for stroke prevention, this treatment modality still lags behind optimal requirements. HYPOTHESIS: Our objectives were to evaluate various doctor or patient-related factors that influence quality of control and to assess the adequacy of anticoagulation provided by physicians in the community. METHODS: In a retrospective study, International Normalized Ratio (INR) values obtained immediately on admission to hospital were considered representative of previous long-term control. RESULTS: Only 42% of the relevant 385 patient population fell within the protective anticoagulation range of INR 1.91-4.1. The respective figures for patients with poor (INR < 1.5) or suboptimal (INR 1.51-1.9) control, as well as those whose INR values risked bleeding (INR > 4.1), were 28.3, 14.1, and 15.6%. Patient involvement in treatment positively influenced quality of control. By contrast, age 70-80 years or absence of congestive heart failure negatively affected quality of anticoagulation [p = 0.07, odds ratio (OR), 1.7 (95% confidence interval. 0.94-3.08), p = 0.014, OR, 2.06 (95% confidence interval, 1.15-3.7) respectively]. The percentage of patients admitted with stroke who had been adequately anticoagulated was significantly lower than that of patients who had no stroke (21 vs. 44.4%). Adequacy of anticoagulation in patients with cardiac prosthetic valves was superior compared with the rest of the patient population (56.7 vs. 42% with optimal, and only 14.5 vs. 28.3% with poor anticoagulation, respectively), indicating that under the same conditions a better quality of treatment could be achieved. CONCLUSIONS: Adequacy of anticoagulation in patients with atrial fibrillation lags behind actual recommendations. Better control is required and achievable.     

Best quality indicator of vitamin K antagonist therapy to predict mortality and bleeding in haemodialysis patients with atrial fibrillation

BackgroundThere is a high prevalence of atrial fibrillation (AF) in patients undergoing haemodialysis. Oral anticoagulant therapy with vitamin K antagonists (VKAs) is the only accepted treatment for the prevention of thromboembolism in haemodialysis patients with AF. However, in this population, the risk of bleeding is greatly increased. The aim of the study was to evaluate the ability of treatment quality indicators of VKA therapy to predict mortality and bleedings in a population of haemodialysis patients with AF.Materials and methodsA total of 129 patients were included in this cohort study. Deaths and bleeding events were recorded during a follow-up of 4 years. In all patients, International Normalized Ratio (INR) values were assessed at least once a month. Time in therapeutic range (TTR) and INR variability, as measured by the standard deviation of INR, were updated at each INR measurement. A Cox model with time-dependent co-variates and sandwich variance was applied.ResultsDuring follow-up, 71 patients died and 55 bleeding episodes occurred in 31 patients. INR variability was the only indicator associated with both mortality (hazard ratio [HR]=1.67, 95% confidence interval [CI] 1.12; 2.49, p=0.012) and bleeding (HR=2.85, 95% CI: 1.71; 4.75, p=0.0001). HR of mortality was higher in patients with INR >3 (HR=2.06, 95% CI: 1.09; 3.88, p=0.0259) than in subjects in therapeutic range 2<INR≤3. TTR was inversely associated with the risk of recurrent haemorrhagic events (HR=0.88, 95% CI: 0.80; 0.95, p=0.0023), but not with a first episode of bleeding. Results were consistent after censoring patients at VKA withdrawal.DiscussionOur study suggests that, in haemodialysis patients with AF taking VKAs, INR variability is the quality indicator that best predicts clinical outcomes. In this population, if more treatment quality indicators are considered together, it may become easier to identify patients at particularly high risk of bleeding and death.     

AFFIRM and RACE Trials: Implications for the Management of Atrial Fibrillation

The Atrial Fibrillation (AF) Follow-up Investigation of Rhythm Management (AFFIRM) and Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation Study (RACE) Trials evaluated strategies of rate control or rhythm control in atrial fibrillation. AFFIRM enrolled patients with recent onset AF, and at entry over half of all patients were in sinus rhythm. At any point in the trial, the achieved difference in cardiac rhythm was likely only about 30%. In RACE all patients were entered in AF, and at the end of the study, sinus rhythm was present in 10% vs 39%. The strategy of rate control was non-inferior to the rhythm control strategy in both trials, and permits consideration of rate control as primary therapy. However, the actual differences in rhythm were relatively small, and do not allow the conclusion that maintenance of sinus rhythm is inferior to non-maintenance.Current guidelines recommend that patients with paroxysmal AF receive warfarin if they have risk factors for stroke. This is supported by data from AFFIRM. Most strokes in AFFIRM occurred either during subtherapeutic INR, or after cessation of warfarin. Since more patients in the rhythm control arm of AFFIRM discontinued warfarin, it is possible that asymptomatic recurrences of paroxysmal AF fostered clot development and embolization. We cannot answer from the data available whether or not it is safe to discontinue anticoagulation if all episodes of AF are suppressed.Among the reasons that AF is associated with increased mortality may be that it encourages development of congestive heart failure or progressive left ventricular dysfunction. Congestive heart failure occurrence was monitored in both trials, and occurred at a rate of 2-5% without significant differences between rate and rhythm arms. In patients with heart failure at entry, a mortality trend in AFFIRM favored the rhythm control arm. The issue of survivorship and rhythm control in AF in congestive heart failure is undergoing further testing.     

高龄持续性心房纤颤患者不同剂量阿司匹林与华法林抗栓疗效及安全性比较

目的观察在持续性心房纤颤（房颤）的高龄患者中,不同剂量阿司匹林及华法林的疗效和安全性。方法选取年龄≥75岁的持续性房颤患者217例,分为4组,华法林高抗凝组『2．0〈国际标准化比率（international normalized ratio,INR）≤3．0154例,华法林低抗凝组（1．6≤INR≤2．0）53例,阿司匹林组（325mg／d）47例,阿司匹林组（200mg／d）63例,观察各组中血栓栓塞和出血事件的发生率。结果华法林高抗凝组与低抗凝组血栓栓塞发生率明显低于阿司匹林组（325mg／d）,差异有统计学意义（矿=6．487,P=O．011;矿=7．929,P=O．005;r=6．354,P=O．012;r=7．771,P=O．005）;华法林高抗凝组出血发生率明显高于低抗凝组和阿司匹林组（200mg／d）,差异有统计学意义（14.8％＇US．0m0,P〈0．05）;华法林高抗凝组与阿司匹林组（325mg／d）出血发生率比较,差异无统计学意义（P〉O．05）。结论对于年龄≥75岁的老年持续性房颤患者,低抗凝强度华法林（1．6≤INR≤2．0）安全有效,其疗效优于阿司匹林。     

Left atrial appendage closure in patients with atrial fibrillation in whom warfarin is contra-indicated: initial South African experience

Abstract

Atrial fibrillation is a common cause of cardiac embolic events, especially stroke. Oral anticoagulation therapy is used to reduce these events. Many patients however are unable to take such therapy. Percutaneous occlusion of the left atrial appendage (the source of 90% of these emboli) is an option in these patients. Presented here are the first 12 patients to have this procedure done in South Africa.     

Stroke event rates in anticoagulated patients with paroxysmal atrial fibrillation

Aims. To test the hypothesis that stroke and systemic embolic events (SEE) in the stroke prevention using an oral thrombin inhibitor in atrial fibrillation (SPORTIF) III and V trials are different between paroxysmal and persistent atrial fibrillation (AF). Methods. Data analysis from two cohorts of patients enroled in the prospective SPORTIF III and V clinical trials (n = 7329); 836 subjects (11.4%) with paroxysmal AF [mean age 70.1 years (SD = 9.5)] were compared with 6493 subjects with persistent AF for this ancillary study. Results. The annual event rates for stroke/SEE are 1.73% for persistent AF and 0.93% for paroxysmal AF. In a multivariate analysis, after adjusting for stroke risk factors, gender and aspirin usage, the differences remained statistically significant with a higher hazard ratio (HR) for stroke/SEE in persistent AF [vs. paroxysmal AF, HR 1.87, 95% confidence interval (CI) 1.04–3.36; P = 0.037]. In ‘high risk’ patients (with ≥2 stroke risk factors) annual event rates for stroke/SEE were 2.08% for persistent AF and 1.27% for paroxysmal AF (adjusted HR = 1.68, 95% CI 0.91–3.1, P = 0.098). Elderly patients had annual event rates for stroke/SEE of 2.38% for persistent AF and 1.13% for paroxysmal AF (adjusted HR = 2.27, 95% CI 0.92–5.59, P = 0.075). Vitamin K antagonist (VKA)‐naïve paroxysmal AF patients had a 1.89%/year stroke/SEE rate, compared with 0.61% for previous VKA takers (HR = 0.33, 95% CI 0.11–1.01, P = 0.052). Conclusion. In this large clinical trial cohort of anticoagulated AF patients, those with paroxysmal AF had stroke rates which were lower than for patients with persistent AF, although both groups had broadly similar stroke risk factors. Subjects with paroxysmal AF at ‘high risk’ had stroke/SEE rates that were not significantly different to persistent AF subjects.