Anticoagulant therapy for the prevention of recurrent stroke in patients with atrial fibrillation: a comprehensive risk management

V A Sorokoumov

doi:10.15829/1728-8800-2022-3122

Abstract

Effective secondary prevention of ischemic stroke in patients with atrial fibrillation (AF) implies long-term oral anticoagulant therapy. It has been proven that the use of direct oral anticoagulants (DOACs) is more effective, safer and more convenient for a patient than vitamin K antagonists. However, the selection of most effective and safe DOAC represented without direct comparisons in randomized controlled trials (RCTs) cannot be reliable due to the inevitable differences in the cohorts of studied patients and differences in methodological approaches. It should be noted that the population of patients in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) in terms of basic characteristics was as close as possible to the Russian population of AF patients compared with study populations of other DOACs. Of great importance for ensuring the overall benefit from DOACs is the possibility of comprehensive protection of the elderly patient with AF. This approach, along with the risk of recurrent stroke and possible bleeding events, takes into account other risks that can significantly worsen the prognosis and health of a patient with AF, such as the risk of coronary events, impairment of renal function, and cognitive impairment that can lead to low adherence to treatment. Rivaroxaban therapy makes it possible to simultaneously reduce the listed risks, providing comprehensive protection for an elderly patient with AF.

Highlights

Эффективная вторичная профилактика ишемического инсульта у пациентов с фибрилляцией предсердий (ФП) подразумевает длительное лечение оральными антикоагулянтами
It has been proven that the use of direct oral anticoagulants (DOACs) is more effective, safer and more convenient for a patient than vitamin K antagonists
The selection of most effective and safe DOAC represented without direct comparisons in randomized controlled trials (RCTs) cannot be reliable due to the inevitable differences in the cohorts of studied patients and differences in methodological approaches

Summary

Introduction

Эффективная вторичная профилактика ишемического инсульта у пациентов с фибрилляцией предсердий (ФП) подразумевает длительное лечение оральными антикоагулянтами. АВК — антагонисты витамина К, ДИ — доверительный интервал, ИИ — ишемический инсульт, ИМ/ОКС — инфаркт миокарда/острый коронарный синдром, ТИА — транзиторная ишемическая атака, ОАК — оральные антикоагулянты, ОР — отношение рисков, ПОАК — прямые оральные антикоагулянты, РКИ — рандомизированное контролируемое исследование, ФП — фибрилляция предсердий, ФР — факторы риска, ХБП — хроническая болезнь почек, ARISTOTLE — Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation, CHADS2 — Congestive Heart failure, Hypertension, Age, Diabetes mellitus, Stroke (2 ball), HAS-BLED — Hypertension, Abnormal renal-liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (65 years), Drugs or alcohol concomitantly, RE-LY — The Randomized Evaluation of Long-Term Anticoagulation Therapy, ROCKET AF — The Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation.

Results

Conclusion