Abstract
Atrial fibrillation continues to be a significant source of morbidity and mortality worldwide. Effective anticoagulation remains the cornerstone of outpatient and inpatient treatment. The use of the new generation of anticoagulants (NOACs) continues to grow. Recently published data indicate their cost-effectiveness and overall safety in stroke prevention; compared to vitamin K antagonists, they can be prescribed in fixed doses for long-term therapy without the need for coagulation monitoring. Both United States and European Guidelines recommend NOACs for stroke prevention in patients with atrial fibrillation. This review discusses each of the NOACs, along with their efficacy and safety data. It explores the most recent guidelines regarding their perioperative use in atrial fibrillation patients. It also discusses bleeding complications, perioperative management, and reversal agents.
Highlights
Atrial fibrillation (AF) is one of the most common tachyarrhythmias in clinical practice
Penado et al showed that the hazard ratio for recurrent stroke among those with AF who were not treated with anticoagulants was 2.1 (95% confidence interval (CI): 1.4 to 2.9; P < 0.001), whereas the hazard ratio for recurrent severe stroke was 2.4 [3]
The analysis showed better safety outcomes associated with new generation of anticoagulants (NOACs); the relative risk (RR) of major bleeding was 0.83
Summary
Atrial fibrillation (AF) is one of the most common tachyarrhythmias in clinical practice. It accounts for about 35% of hospital admissions from cardiac arrhythmias. AF increases the risk of stroke 4-5-fold, independent of other cardiac or noncardiac morbidities [2]. At least 15–20% of all ischemic strokes are due to AF. AF is an independent risk factor for stroke recurrence [3]. Penado et al showed that the hazard ratio for recurrent stroke among those with AF who were not treated with anticoagulants was 2.1 (95% confidence interval (CI): 1.4 to 2.9; P < 0.001), whereas the hazard ratio for recurrent severe stroke was 2.4 (95% CI: 1.6 to 3.6; P < 0.001) [3]
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