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Updated: Jul 2, 2025
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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
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Current Gaps in the Provision of Safe and Effective Anticoagulation in Atrial Fibrillation and the Potential for
Shaun G Goodman1,2, Denis Roy3, Charles V Pollack4
1From the Division of Cardiology, St Michael's Hospital, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada.
Critical Pathways in Cardiology
|February 21, 2024
Summary
Stroke prevention in atrial fibrillation is suboptimal due to underprescribing and poor adherence to anticoagulation. New factor XI-directed anticoagulants may offer improved safety and efficacy for patients.
Area of Science:
- Cardiology
- Hematology
- Pharmacology
Background:
- Global atrial fibrillation (AF) prevalence is rising, increasing stroke risk.
- Anticoagulation therapy reduces stroke risk in AF but is underutilized and suboptimal.
- Advances in anticoagulants (e.g., DOACs) improved safety but population-level stroke protection remains poor.
Purpose of the Study:
- To address gaps in anticoagulation therapy for stroke prevention in AF.
- To discuss challenges in current anticoagulation management.
- To explore the potential of factor XI-directed anticoagulants for improved stroke prevention.
Main Methods:
- A multidisciplinary panel convened at the 2023 International Society of Thrombosis and Haemostasis Congress.
- Discussion focused on recognizing and addressing therapeutic gaps.
- Reevaluation of coagulation cascade principles was proposed.
Main Results:
- Current anticoagulation for AF stroke prevention faces multifactorial deficits.
- Underprescribing, drug limitations, and poor patient adherence contribute to suboptimal outcomes.
- Factor XI-directed anticoagulants present a potential advancement.
Conclusions:
- Optimizing stroke prevention in AF requires addressing prescribing and adherence barriers.
- Understanding hemostasis and thrombosis separately is crucial.
- Factor XI inhibitors may offer a safer and more effective anticoagulation strategy.
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