Emerging Tools for Stroke Prevention in Atrial Fibrillation

• Published in: EBioMedicine Vol. 4; no. C; pp. 26 - 39
• Main Authors: Voukalis, Christos, Lip, Gregory Y.H., Shantsila, Eduard
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.02.2016; Elsevier
• Subjects: 4-Hydroxycoumarins - administration & dosage; 4-Hydroxycoumarins - therapeutic use; Animals; Anticoagulants - administration & dosage; Anticoagulants - therapeutic use; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - drug therapy; Humans; Net clinical benefit; Non-vitamin K oral anticoagulants; Oral anticoagulation; Review; Risk stratification; Stroke - drug therapy; Stroke - etiology; Stroke - prevention & control; Stroke prevention; Vitamin K - antagonists & inhibitors; ESRF; HTN; NVAF; DM; LV; INR; SE; Stroke prevention; Oral anticoagulation; TTR; Risk stratification; CKD; eGFR; Atrial fibrillation; NCB; TIA; RSM; Non-vitamin K oral anticoagulants; ICH; TE; Net clinical benefit; PCI; CrCl; NICE; HF; eGFR, estimated glomerular filtration rate; ESRF, end stage renal failure; HTN, hypertension; HF, heart failure; CKD, chronic kidney disease; TE, thromboembolic episode; ICH, intracranial haemorrhage; PCI, percutaneous coronary intervention; CrCl, creatinine clearance; LV, left ventricle; TIA, transient ischaemic attack; DM, diabetes mellitus; NICE, National institute for Health and Care Excellence; TTR, time in therapeutic range; RSM, risk stratification model; NCB, net clinical benefit; SE, systemic embolism; INR, international normalised ratio; NVAF, non-valvular atrial fibrillation
• ISSN: 2352-3964; 2352-3964
• DOI: 10.1016/j.ebiom.2016.01.017

Ischaemic strokes resulting from atrial fibrillation (AF) constitute a devastating condition for patients and their carers with huge burden on health care systems. Prophylactic treatment against systemic embolization and ischaemic strokes is the cornerstone for the management of AF. Effective stroke prevention requires the use of the vitamin K antagonists or non-vitamin K oral anticoagulants (NOACs). This article summarises the latest developments in the field of stroke prevention in AF and aims to assist physicians with the choice of oral anticoagulant for patients with non-valvular AF with different risk factor profile. •Vitamin K antagonists (VKA) or non-VKA oral anticoagulants should be used for stroke prevention in atrial fibrillation.•Antiplatelet agents should not be prescribed solely for thromboprophylaxis in atrial fibrillation.•Stroke risk should be assessed using the CHA2DS2-VASc score, and bleeding risk with the HAS-BLED score.•The net clinical benefit favours oral anticoagulation with non-VKA oral anticoagulants in presence of at least 1 risk factor.