La fibrillation atriale : un facteur ou un marqueur du risque thromboembolique ? Du concept à la thérapie

Abstract

The main complication of atrial fibrillation is stroke. Twenty years ago, the interest of vitamin K antagonist has been clearly demonstrated but these drugs are difficult to manage. For the last 10 years, direct oral anticoagulants have been developed. These drugs have demonstrated a non-inferiority as compared to vitamin K antagonist and a clear decrease in intra cerebral hemorrhages. Anticoagulation is indicated in a large majority of patients with atrial fibrillation. Nevertheless, many points remained questionable, like the anticoagulation of low risk patients, the choice of oral anticoagulants dosages, the anticoagulation according to the type of atrial fibrillation and the strategy in coronary artery disease patients for example. Recently it has been demonstrated that in many patients there were no temporal relationship between the occurrence of atrial fibrillation episodes and stroke. That means that in many cases atrial fibrillation is not the factor but the marker of thromboembolic risk.