[Anticoagulation and new therapeutic options in atrial fibrillation]

Area of Science:

• Cardiology
• Pharmacology
• Medical Devices

Background:

• Atrial fibrillation necessitates oral anticoagulation to mitigate stroke risk.
• Risk stratification using CHA₂DS₂-VASc and HAS-BLED scores is essential for treatment decisions.
• Oral anticoagulation is indicated for valvular atrial fibrillation and CHA₂DS₂-VASc scores of 1-2 or higher, regardless of AF type.

Purpose of the Study:

• To outline the indications and considerations for oral anticoagulation in atrial fibrillation.
• To highlight non-vitamin K antagonists (NOAKs) as first-line therapy.
• To present percutaneous left atrial appendage closure as an alternative treatment.

Main Methods:

• Review of current guidelines and clinical practices for atrial fibrillation management.
• Assessment of stroke and bleeding risk factors using established scoring systems.
• Evaluation of non-vitamin K antagonists (NOAKs) and percutaneous left atrial appendage closure.

Main Results:

• Oral anticoagulation is indicated for most atrial fibrillation patients to reduce stroke risk.
• CHA₂DS₂-VASc and HAS-BLED scores guide the assessment of stroke and bleeding risks.
• Non-vitamin K antagonists (NOAKs) are frequently the first-line treatment choice.
• Percutaneous left atrial appendage closure offers an alternative for patients with contraindications to oral anticoagulation.

Conclusions:

• Oral anticoagulation is a cornerstone in managing atrial fibrillation to prevent stroke.
• Risk assessment scores are vital for tailoring anticoagulation therapy.
• Drug selection for anticoagulation should consider patient and physician preferences, renal function, co-medications, and bleeding risk.
• Percutaneous left atrial appendage closure provides a valuable alternative for select patients.