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Antithrombotic therapy for stroke prevention in patients with atrial fibrillation in Japan
Tatsuya Maruhashi1, Yukihito Higashi1,2
1Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University , Hiroshima, Japan.
Insights
Improving oral anticoagulant therapy for atrial fibrillation (AF) in Japan is crucial. Guidelines recommend appropriate direct oral anticoagulant (DOAC) dosing and duration to prevent stroke and bleeding complications.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Stroke is a significant public health concern in Japan, with rising rates of atrial fibrillation (AF) due to an aging population.
- Effective oral antithrombotic therapy is essential for preventing AF-related strokes and managing bleeding risks.
Purpose of the Study:
- To summarize Japanese guidelines for antithrombotic therapy in AF patients.
- To review the current status and future perspectives of antithrombotic therapy for AF in Japan.
Main Methods:
- Review of Japanese guidelines for antithrombotic therapy.
- Analysis of current practices and future trends in AF treatment.
Main Results:
- Warfarin adherence may be difficult to improve; DOACs have increased oral anticoagulant use in AF patients.
- Inappropriate DOAC dose reduction, especially due to age, is increasing and should be avoided.
- Prolonged triple or dual therapy in AF patients with coronary artery disease increases bleeding risk.
Conclusions:
- Avoid inappropriate DOAC dose reduction in elderly AF patients to reduce stroke risk.
- Shorten triple or dual therapy duration in AF patients with CAD to minimize major bleeding.
- Simplified 2020 guideline recommendations may promote shorter antithrombotic durations.
Introduction:
Stroke remains one of the major public health problems in Japan. The number of patients with atrial fibrillation (AF) has been steadily increasing with the aging of the Japanese population. Appropriate oral antithrombotic therapy is necessary to prevent AF-related stroke and bleeding complications.
Areas Covered:
The authors summarize the Japanese guidelines for antithrombotic therapy, as well as the current status of antithrombotic therapy, and future perspectives for antithrombotic therapy for patients with AF in Japan.
Expert Opinion:
Further improvement in adherence to guideline-recommended warfarin therapy may be difficult to achieve. After the introduction of direct oral anticoagulants (DOACs) into clinical practice, the proportion of patients with AF receiving oral anticoagulant therapy has increased in Japan. However, the proportion of patients treated with inappropriately reduced doses of DOACs has also been increasing. Inappropriate dose reduction of DOACs simply because of advanced age should be avoided to reduce stroke events in patients with AF. Among patients with AF receiving anticoagulant therapy who have coronary artery disease, inappropriately prolonged triple therapy or dual therapy should be avoided to reduce major bleeding complications. Shortening the duration of triple therapy or dual therapy may be promoted by simplified recommendations in the 2020-updated guidelines supported by solid evidence.
