Anticoagulation and new therapeutic options in atrial fibrillation

Abstract

Oral anticoagulation plays an essential role in the treatment of patients with atrial fibrillation as it is indicated for most patients to reduce the risk of stroke. It is prudent to assess the risks of stroke and bleeding using the CHA2DS2-VASc and HAS-BLED scores. Oral anticoagulation is indicated in general for all patients with valvular atrial fibrillation (atrial fibrillation in moderate to severe mitral stenosis or mechanical prosthetic valve) as well as for patients with a CHA2DS2-VASc-Score of 1 - 2 points or higher. The indication is irrespective of the form of atrial fibrillation: paroxysmal, persistent or permanent.Non-vitamin K antagonists (NOAK) are first-line therapy for many patients. The selection of the appropriate drug should be based on preference of patient and physician as well as other factors such as renal insufficiency, co-medication and bleeding risk.Percutaneous left atrial appendage closure is a therapeutic alternative especially for patients with a contraindication for oral anticoagulation.