Abstract
Atrial Fibrillation (AF) is the most common sustained arrhythmia and 1/6 strokes is attributed to AF. The cornerstone of treatment remains maintaining sinus rhythm or appropriate ventricular rate control in addition to prevention of stroke. Oral anticoagulation therapy (OAC) with vitamin K antagonists (VKAs) has been the gold standard for almost 50 years and a significant reduction in the risk of stroke in patients with AF has been demonstrated. Nonetheless, only 50% of patients with guideline recommendations for OAC treatment actually receive VKAs and half of these will discontinue therapy within 3 to 5 years with only another half achieving therapeutic ranges more than 50% of the time. The aforementioned limitations in addition with frequent blood monitoring have prompted the development of a series of new OAC therapies. The present review focuses on the current pharmacological management for stroke prevention in patients with AF based on current and emerging evidence.
Highlights
Atrial Fibrillation (AF) is the most common sustained arrhythmia
The present review focuses on the current pharmacological management for stroke and systemic embolism prevention based on current and emerging evidence derived from large randomized clinical trials
The Cardiovascular Society (CCS)-AF guidelines recommend for patients at moderate and high risk preference to dabigatran rather than warfarin based on the risk benefit profile with non-inferior/superior efficacy and a better bleeding profile at the low dose (110 mg/bid) approved for prescription in Canada [7]
Summary
Atrial Fibrillation (AF) is the most common sustained arrhythmia. It affects 1–2% of the general population and is associated with an increased risk of stroke, and several studies suggest that 1/6 strokes may be attributed to AF [1,2]. The primary goals of the pharmacological management of AF are fourfold: (1) Symptom relief (i.e., rate or rhythm control strategies), (2) Control of risk factors that promote and facilitate AF (i.e., upstream therapy, ACE inhibitors, aldosterone receptor blockers, statins, etc.), (3) Stroke and systemic embolism prevention, and (4) Reduction in mortality and morbidity associated with AF. The present review focuses on the current pharmacological management for stroke and systemic embolism prevention based on current and emerging evidence derived from large randomized clinical trials
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