Oral Anticoagulants In Atrial Fibrillation Patients Research Articles

Clinical Implications from Recent Trials and New Guidelines for Stroke Prevention in Atrial Fibrillation

After the release of the 2010 guidelines of the European Society of Cardiology (ESC) and the 2011 update of the guidelines of the American Heart Association/American College of Cardiology (AHA/ACC), new evidence has emerged that requires adaption of current clinical practice in the treatment of atrial fibrillation (AF). In 2011, results were published from two central AF trials concerning prevention of stroke in patients with AF: the Rivaroxaban Once daily oral direct factor Xa inhibition Compared with vitamin K antagonist for prevention of stroke and Embolism Trial in Atrial Fibrillation (ROCKET-AF) and the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) study. Other important aspects that have emerged since 2010 include findings of stroke risk in paroxysmal AF patients, prediction for AF-associated stroke and haemorrhage, risk–benefit considerations concerning oral anticoagulation in patients with chronic kidney disease and risk–benefit considerations with use of antiplatelet agents, alone, combined, or in combination with oral anticoagulants in AF patients. Canadian AF guidelines were updated earlier this year, incorporating the new evidence. Also, in 2012, the American College of Chest Physicians released guidelines for the antithrombotic therapy of AF. Similar updates of the ESC and the AHA/ACC guidelines are expected, which will include new findings from the cardiovascular congresses over the upcoming months. Additionally, also in 2012, the Heart Rhythm Society, the European Heart Rhythm Association and the European Cardiac Arrhythmia Society (HRS/EHRA/ECAS) released a consensus statement on the interventional treatment of AF. The following short review summarises these new data and furthermore highlights our current clinical practice.

Percutaneous closure of the left atrial appendage in atrial fibrillation: an alternative if standard treatment fails?

Atrial fibrillation (AF) is a frequently observed arrhythmia. Its incidence increases with age, reaching approximately 10% in octogenarians. Furthermore, AF is responsible for 15% of all ischemic strokes and up to 25% of all ischemic strokes in octogenarians. In patients with nonrheumatic AF, 90% of all thrombi in the left atrium are found in the left atrial appendage (LAA). In most cases of AF in particular, the administration of oral anticoagulants (OACs) is warranted. To guide the usage of OACs in AF patients, the CHADS2 score (C: congestive heart failure, H: hypertension, A: age greater than or equal to 75 years, D: diabetes, S: prior stroke or transient ischemic attack) was developed; applying this score reduced the number of thromboembolic events by 60 to 70%. However, when contra-indications for OACs are present, or when OACs have failed, no equivalent therapeutic alternative is available. OACs are then frequently replaced by antiplatelets, but these are much less effective than OACs in preventing ...

Use and Underuse of Oral Anticoagulation for Stroke Prevention in Atrial Fibrillation: Old and New Paradigms

Atrial fibrillation (AF) is the most common sustained arrhythmia of the Western world. The increased ischemic stroke risk of the AF patient is one of the most important clinical issues to manage. Despite the well-known benefit of oral anticoagulation in high-risk AF patients, these drugs are widely underused in daily practice all over the world. We describe old and new paradigms of the use of oral anticoagulation. In the future, increased comprehensibility of stroke risk scores, development of a validated clinical bleed risk score, and new patient and physician user-friendly antithrombotic medication may contribute to improved adequate use of oral anticoagulation in AF patients.