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Updated: May 9, 2026

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

[Cerebral embolism and atrial fibrillation]

Yoshikazu Uesaka1

  • 1Department of Neurology, Toranomon Hospital, Tokyo, Japan.

Brain and Nerve = Shinkei Kenkyu No Shinpo
|July 9, 2013
PubMed

Insights

Warfarin anticoagulation for atrial fibrillation (Af) in Japan is often insufficient, and combining it with antiplatelets is harmful. New oral anticoagulants (NOACs) offer convenience and safety but require proper usage guidelines.

Area of Science:

  • Cardiology
  • Neurology
  • Pharmacology

Context:

  • Atrial fibrillation (Af) is a primary cause of cerebral embolisms.
  • Warfarin anticoagulation is prevalent in Japan but often sub-therapeutic.
  • Concomitant use of warfarin and antiplatelets lacks evidence and poses risks.

Purpose:

  • To review the challenges of warfarin therapy in Af patients.
  • To evaluate the role and risks of antiplatelets in Af.
  • To discuss the advantages and uncertainties surrounding new oral anticoagulants (NOACs).

Summary:

  • Warfarin therapy for Af in Japan frequently shows insufficient anticoagulation intensity.
  • Evidence does not support the efficacy of antiplatelets for embolism prevention in Af.
  • Concomitant warfarin and antiplatelet use is potentially harmful, particularly concerning intracranial hemorrhage.
  • New oral anticoagulants (NOACs) present a more convenient and safer alternative, enabling broader application in lower-risk patients.
  • Optimal strategies for utilizing the different available NOACs remain to be clarified.

Impact:

  • Highlights the need for optimized anticoagulation strategies in Af.
  • Warns against the unproven and risky combination of warfarin and antiplatelets.
  • Suggests NOACs can expand anticoagulation therapy to broader patient populations.
  • Identifies a critical knowledge gap in the clinical application of NOACs.

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