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[Prevention of embolisms in atrial fibrillation: anticoagulation and antiplatelet therapy]
1Med. Klinik und Poliklinik, Univ. Münster.
Insights
Oral anticoagulation significantly reduces stroke risk by over 60% in nonvalvular atrial fibrillation patients. This therapy, with a target INR of 2.0-3.0, offers a favorable benefit-to-risk profile for thromboembolism prevention.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Context:
- Nonvalvular atrial fibrillation (NVAF) poses a significant stroke risk (approx. 5% annually).
- Secondary prevention shows a 12% annual recurrence rate after transient ischemic attack or minor stroke.
- Six prospective randomized trials have established new prevention standards.
Purpose:
- To evaluate the efficacy and safety of oral anticoagulation in NVAF.
- To assess risk stratification for thromboembolic complications.
- To guide anticoagulant therapy intensity and alternative treatments.
Summary:
- Oral anticoagulation demonstrates a > or = 60% reduction in thromboembolic events.
- A reduced intensity regimen (target INR 2.0-3.0) is effective for most patients.
- Clinical and echocardiographic features aid in individual benefit-to-risk assessment.
Impact:
- Establishes oral anticoagulation as a primary and secondary prevention standard for NVAF.
- Identifies patient subgroups for tailored thromboembolism risk management.
- Positions aspirin as a second-line therapy for specific patient populations.
Abstract:
Over the past five years, the results of six prospective randomized trials have set new standards in the primary and secondary prevention of thromboembolism in "nonvalvular" ("nonrheumatic") atrial fibrillation. On the one hand, they have confirmed the increased risk of stroke in these patients amounting to about 5% per year and an annual recurrence rate after a recent transient ischaemic attack or minor stroke of 12%. On the other hand, the results of these trials have unanimously demonstrated a > or = 60% risk reduction with oral anticoagulation at an acceptable risk of major bleeding complications. A reduced intensity of anticoagulant therapy with a target INR of 2.0-3.0 is effective in most of these patients. Both clinical and echocardiographic features allow the identification of subgroups at low or high risk of thromboembolic complications and provide the basis for the individual benefit-to-risk assessment of anticoagulant therapy. Aspirin is currently recommended as a second choice therapy for patients who are poor candidates for oral anticoagulants or who are considered to be at low risk for thromboembolism.