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Tailored Practical Management of Patients With Atrial Fibrillation: A Risk Factor-Based Approach

Daniele Pastori1, Danilo Menichelli1, Rony Gingis1

  • 1I Clinica Medica, Atherothrombosis Centre, Department of Internal Medicine and Medical Specialties of Sapienza University, Rome, Italy.

Frontiers in Cardiovascular Medicine
|March 28, 2019
PubMed

Insights

Managing atrial fibrillation (AF) involves replacing warfarin with non-vitamin K antagonist oral anticoagulants (NOACs). A personalized strategy, assessing individual risks, is crucial for reducing cardiovascular events in AF patients.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Atrial fibrillation (AF) management has shifted from vitamin K antagonists to non-vitamin K antagonist oral anticoagulants (NOACs).
  • Despite NOACs' efficacy in reducing ischemic stroke, cardiovascular events remain high in AF patients.
  • A comprehensive, individualized approach is needed to mitigate both thromboembolic and cardiovascular risks.

Purpose of the Study:

  • To present an individual-based strategy for managing antithrombotic therapy in atrial fibrillation (AF) patients.
  • To guide tailored prescription and monitoring of NOACs based on patient-specific risk factors.
  • To provide updated management strategies for AF patients in specific clinical scenarios.

Main Methods:

  • Review of current literature on antithrombotic therapy in AF.
  • Discussion of risk stratification scores for thromboembolic and bleeding events.
  • Outline of practical management strategies for NOACs in various clinical situations.

Main Results:

  • NOACs are replacing vitamin K antagonists for thromboprophylaxis in AF.
  • Individualized risk assessment is key to selecting appropriate anticoagulant therapy.
  • Specific guidance is provided for managing bleeding, treatment switches, post-stroke anticoagulation, and concurrent cardiovascular conditions.

Conclusions:

  • A tailored, risk-factor-based approach is essential for optimizing AF patient care.
  • Personalized NOAC management can reduce thromboembolic and cardiovascular events.
  • This review offers a practical framework for clinicians managing AF patients with complex needs.
Keywords:
ABCNOACatrial fibrillationbleedingpractical managementscores

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