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

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Stroke prevention in atrial fibrillation – latest guideline recommendations and real world data

Victoria Johnson, Jörn Schmitt, Christian W Hamm

    Medizinische Monatsschrift Fur Pharmazeuten
    |June 29, 2018
    PubMed

    Insights

    Non-vitamin K antagonist oral anticoagulants (NOACs) are recommended for stroke prevention in atrial fibrillation (AF). Real-world data confirm NOACs are safe and effective, with specific antidotes becoming available.

    Area of Science:

    • Cardiology
    • Pharmacology
    • Public Health

    Background:

    • Atrial fibrillation (AF) affects 1% of the general population, rising to 8% in those over 80.
    • AF increases risks of palpitations, tachycardia, heart failure hospitalizations, and stroke.
    • Oral anticoagulation is crucial for stroke prevention in AF patients.

    Purpose of the Study:

    • To review current guidelines and evidence regarding anticoagulation in atrial fibrillation.
    • To highlight the advantages of non-vitamin K antagonist oral anticoagulants (NOACs) over vitamin K antagonists.
    • To discuss the safety, feasibility, and antidote availability for NOACs.

    Main Methods:

    • Review of 2016 guidelines for atrial fibrillation management.
    • Analysis of randomized controlled trials and real-world data on NOACs.
    • Examination of contraindications and antidote developments for NOACs.

    Main Results:

    • Non-vitamin K antagonist oral anticoagulants (NOACs) are preferred over vitamin K antagonists due to reduced bleeding risk, particularly intracranial hemorrhage.
    • Real-world data support the safety and feasibility of NOAC use in atrial fibrillation.
    • Antiplatelet therapy is no longer indicated for stroke prevention in AF.
    • NOACs are contraindicated in patients with mechanical valve replacement and valvular atrial fibrillation.

    Conclusions:

    • NOACs represent a preferred and effective strategy for stroke prevention in atrial fibrillation.
    • The availability of specific antidotes enhances the safety profile of NOACs.
    • Ongoing research and real-world evidence continue to support the role of NOACs in AF management.

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