Related Experiment Videos
[Prevention of thromboembolism in non-rheumatic atrial fibrillation: an update]
1Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi, Ospedale Ex Busonera Via Gattamelata, 64 35128 Padova. vittorio.pengo@unipd.it
Insights
Oral anticoagulants effectively prevent stroke in nonrheumatic atrial fibrillation, especially for older patients or those with risk factors. Elderly patients require careful benefit/risk assessment due to increased bleeding risk.
Area of Science:
- Cardiology
- Pharmacology
- Geriatrics
Context:
- Nonrheumatic atrial fibrillation (AF) poses a significant risk of systemic thromboembolism.
- Oral anticoagulants (OACs) are established therapies for stroke prevention in AF.
- Risk stratification is crucial for optimizing OAC therapy.
Purpose:
- To review the efficacy and safety of OACs in nonrheumatic AF.
- To identify patient subgroups benefiting most from OACs.
- To discuss considerations for OAC use in elderly patients and alternative antiplatelet strategies.
Summary:
- Randomized trials confirm OAC efficacy and safety for preventing systemic thromboembolism in nonrheumatic AF.
- Major benefits observed in patients >75 years, with hypertension, heart failure, or prior thromboembolism, or with two minor risk factors (65-75 years, diabetes, ischemic heart disease).
- All patients >75 with AF should receive OACs targeting an INR of 2.0-3.0, with careful benefit/risk evaluation due to age-related bleeding risk. Aspirin may be suitable for medium-risk patients or those with high bleeding risk.
Impact:
- Provides evidence-based recommendations for OAC use in nonrheumatic AF.
- Highlights the importance of individualized treatment strategies, particularly in elderly populations.
- Informs clinical practice regarding stroke prevention in atrial fibrillation and the role of antiplatelet agents.
Abstract:
Randomized clinical trials have demonstrated the efficacy and safety of oral anticoagulants in the prevention of systemic thromboembolism in nonrheumatic atrial fibrillation. The benefit of this treatment is particularly evident in patients in whom atrial fibrillation is associated with a major risk factor for systemic thromboembolism (patients > 75 years of age, history of hypertension, previous left ventricular failure or previous systemic thromboembolism) or those in whom two minor risk factors are present (patients between 65 and 75 years of age, diabetes, ischemic heart disease). According to these recommendations, all the patients > 75 years of age with chronic or paroxysmal atrial fibrillation should receive oral anticoagulant treatment to maintain an INR between 2.0 and 3.0. However, as the risk of bleeding during oral anticoagulant treatment increases with age, the benefit/risk ratio should always be evaluated in elderly patients. Although high risk patients do not benefit from aspirin treatment, aspirin or other antiplatelet agents might be indicated in medium risk patients or in those in whom the risk of bleeding with oral anticoagulants is considered too high. New antithrombotic regimens will be tested in the near future.