Stroke Prevention in Atrial Fibrillation

Literature review: stroke prevention in atrial fibrillation

The review includes the pivotal randomised controlled trials for warfarin and direct oral anticoagulants as well as relevant publications from the last 18 months. The following search terms were used: ‘stroke prevention’, ‘atrial fibrillation’, dabigatran, rivaroxaban, apixaban, edoxaban, warfarin, ‘oral anticoagulants’, ‘non-VKA oral anticoagulants’, novel oral anticoagulants’, ‘direct oral anticoagulants’, ‘reversal agents’

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Key Articles

Independent Medical Education

Guidelines/ Expert Recommendations

Randomised Controlled Trials

Meta-Analyses

Real World / Retrospective Studies

Post-Hoc/Subgroup Analysis Of Pivotal Trials - Dabigatran

Post-Hoc/Subgroup Analysis Of Pivotal Trials - Rivaroxaban

Post-Hoc/Subgroup Analysis Of Pivotal Trials - Edoxaban

Post-Hoc/Subgroup Analysis Of Pivotal Trials - Apixaban

Post-Hoc/Subgroup Analysis Of Pivotal Trials - Diabetes

Post-Hoc/Subgroup Analysis Of Pivotal Trials - Elderly

Post-Hoc/Subgroup Analysis Of Pivotal Trials - Hypertension

Post-Hoc/Subgroup Analysis Of Pivotal Trials - Valvular

Other Studies

Reviews/Others

Specific Clinical Indications

Practical Aspects of Use

Reversal Agents

Ablation strategies

Stroke prevention in atrial fibrillation

Despite the evidence-based guidelines for the management of atrial fibrillation (AF), serious gaps continue to exist between clinical knowledge and practice, leaving patients at risk for disabling strokes. It is estimated that up to 67% of AF-related strokes are preventable. The significant increase in mortality and functional impairment is even more alarming, compared to non-AF strokes.

Updated AF treatment guidelines recommend new oral anticoagulants (NOACs) over warfarin for stroke prevention except, in patients with moderate to severe mitral stenosis or a mechanical heart valve. Based on some recent trials, NOACs were superior to warfarin for the prevention of the composite of stroke and systemic embolism in patients with AF and an additional risk factor for stroke. Reversal agents are now also available for NOACs in patients for severe bleeding or emergency procedures.

With the increased utilization of NOACs, it is critical for the clinician to understand the clinical and practical usage of these agents in diverse patient populations and clinical situations.

Radcliffe Cardiology would like to thank Boehringer Ingelheim for their support in the development of this section.

Boehringer Ingelheim

For any follow up questions please contact your local Boehringer Ingelheim representative

  • Craig T. January, Hugh Calkins, Lin Y. Chen, et al

    A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. The purpose of this document is to update the “2014 AHA/ACC/HRS Guideline for the Management of...

    Circulation. 2019;139:e000–e000
  • William T Cefalu, James L Januzzi Jr, Mikhail Kosiborod, et al

    The purpose of this document is to summarize key elements from emerging studies, and to provide succinct, practical guidance on the use of specific glucose-lowering agents for reducing CV risk in patients with T2D and clinical atherosclerotic...

    JACC, ISSN: 1558-3597, Vol: 72, Issue: 24, Page: 3200-3223
  • Beatriz Tose Costa Paiva, Johannes Brachmann

     This review comprehensively summarizes current trial data on rhythm and rate control strategies in atrial fibrillation with a special focus on catheter ablation of AF in HF patients.

    Atrial fibrillation (AF) and heart failure (HF) are...

    Clin Cardiol. 2019; 42: 400– 405.
  • Atul Verma

    Emerging data suggest that POAF after cardiac surgery is not a transient, self-resolving phenomenon. Rather, its occurrence is associated with future risk of atrial fibrillation and long-term adverse outcomes such as stroke and death. This...

    Curr Opin Cardiol. 24 December, 2018. Epub ahead of print.

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