Management of patients with atrial fibrillation at high risk of stroke: current treatment options

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ID: 6831
2012
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Abstract
Management of patients with atrial fibrillation at high risk of stroke: current treatment options Duncan Edwards, Keara Harris, Jonathan MantPrimary Care Unit, University of Cambridge, Cambridge, UKAbstract: Atrial fibrillation (AF) is common, and is associated with an increased risk of stroke. Patients' absolute risk of stroke depends on the presence or absence of additional risk factors as well as AF, including prior thromboembolism, increased age, hypertension, diabetes, structural heart disease, and female sex. The risk to benefit ratio of stroke prevention therapy differs according to the patients' absolute risk. There is evidence that even those with an estimated annual stroke risk of 2%–4%, who were once classified as medium risk, would benefit from anticoagulation and should be included in an expanded high-risk category. Alternatives to anticoagulation include the restoration of sinus rhythm and left atrial appendage surgery, but these may not be suitable for many high-risk patients with comorbidities. Antiplatelets are substantially less effective than anticoagulation and cause similar rates of bleeding. Self-monitoring and computerized decision support increases the time in therapeutic range and effectiveness of vitamin K antagonists. Novel oral anticoagulants including dabigatran, rivoraxaban, and apixaban have been shown to be noninferior to warfarin, do not require monitoring, and increase the prescribing options for stroke prevention in AF.Keywords: stroke prevention, atrial fibrillation, anticoagulants, primary prevention
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duncan2012managementresearch Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Duncan Edwards;Keara Harris;Jonathan Mant and
Journal research reports in clinical cardiology
Year 2012
DOI
10.2147/RRCC.S16754
URL
Keywords Keywords not found

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