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Question answered:09/05/06 Warning! this question is over two years old.
PRODIGY, in their guideline on AF devote a section to paroxysmal AF, which discusses management. This is too large to reproduce here so we recommend you read the article via the URL in the reference section. However, we’ll reproduce a few points below:
“The risk of thromboembolism is probably the same as that for permanent AF, and the same criteria for antithrombotic treatment apply (A).”
“Treatment may not be necessary if symptomatic episodes are mild, infrequent, and short. The benefits of treatment have to be balanced against the risks of long-term anti-arrhythmic medication”
“Antithrombotic treatment
There is an 18-fold increase in the risk of thromboembolism in people with atrial fibrillation (AF) and rheumatic mitral stenosis. Despite the few randomized trials carried out, it is accepted that such people should be treated with warfarin (C).
AF increases the risk of thromboembolism by a factor of about six even in the absence of mitral valve disease (i.e. non-valvular AF). Warfarin, and also aspirin, have been shown to reduce the risk of stroke in these people, although the reduction is larger and more consistent with warfarin.
Warfarin reduces the risk of stroke by nearly two-thirds, while aspirin reduces the risk by about a fifth.
- Note: the overall incidence of stroke is about 5% per year in people with non-valvular AF. However, there is a wide variation in risk, depending on a person's age, and the presence of any additional risk factors (e.g. hypertension, heart failure, diabetes, previous stroke, or previous transient ischaemic attack [TIA]).
- The decision to use warfarin or aspirin should ultimately be based on the balance of an individual's overall risk of stroke compared with the risk of adverse effects.”
It also has a section ‘Who should receive antithrombotic prophylaxis?’
References
1) PRODIGY. Atrial fibrillation. 2003 (http://www.prodigy.nhs.uk/ProdigyKnowledge/Guidance/WholeGuidanceView.aspx?GuidanceId=37285)
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