Stroke In AF Research Articles

Right Atrial Fluorodeoxyglucose Uptake Is a Risk Factor for Stroke and Improves Prediction of Stroke Above the CHA2DS2-VASc Score in Patients With Atrial Fibrillation.

BackgroundAtrial fibrillation (AF) is a common arrhythmia, and its most severe and dreaded complication is stroke. The CHA2DS2-VASc score is currently recommended for stroke risk assessment in AF. We aimed to explore the relationship between atrial FDG uptake and stroke and whether atrial FDG uptake could provide incremental value above the CHA2DS2-VAS score to predict stroke in AF by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT).Materials and MethodsFrom September 2017 to December 2020, we retrospectively enrolled 230 patients (115 with AF and 115 without AF as the non-AF group, matched for the date of PET/CT examination and the basic characteristics of the patient) who underwent 18F-FDG PET/CT due to tumor screening or preoperative staging after prolonged fasting and followed up for at least 12 months from the date of PET/CT examination; the endpoint event is the occurrence of stroke. We visually and quantitatively analyzed 18F-FDG uptake in the right and left atria (RA/LA), right and left atrial appendage (RAA/LAA), right and left ventricle (RV/LV), and collected clinical features. In addition, according to the endpoint event (stroke), the enrolled population was divided into the stroke group and non-stroke group, and relevant clinical features and atrial FDG uptake indicators of the two groups were analyzed. Univariate and multivariate Cox regression analyzes were used to analyze the risk factors of stroke events. The Kaplan–Meier survival curve of atrial FDG uptake was drawn, and the log-rank method was used to compare the differences in the survival curves of the two groups. Receiver operating characteristic (ROC) curves were used to examine the discriminatory power of atrial FDG uptake in predicting stroke and determine whether the addition of atrial FDG uptake improves predictive value beyond the CHA2DS2-VASc score for stroke.ResultsIn the AF group, more than half of patients had RA FDG uptake and one-fifth had LA FDG uptake, while one patient had RA FDG uptake and two patients had LA FDG uptake in the non-AF group. In quantitative analysis, the maximum standardized uptake value (SUVmax) of the RA and LA in the AF group was significantly higher than that of the non-AF group (all P < 0.001). We followed up the patients for 28 ± 10 months, and finally, 31 patients had stroke. In the stroke group, atrial fibrillation, RA SUVmax, RAA SUVmax, LAA SUVmax, age ≥ 75 years, and left atrial dilation were significantly higher than those of the non-stroke group (all P < 0.05). Multivariate Cox regression analysis showed that high RA SUVmax (RA SUVmax ≥ 2.62) was an independent risk factor for stroke (HR = 4.264, 95% CI 1.368–13.293, P = 0.012). By using the log-rank test, patients with high RA SUVmax had a significantly higher incidence of stroke compared with patients with low RA SUVmax (P < 0.001). Addition of high RA SUVmax to the CHA2DS2-VASc score could predict stroke more effectively, with a larger AUC 0.790 (P < 0.001).ConclusionThis study found a significant correlation between atrial FDG uptake and AF, especially in RA. Meanwhile, RA FDG uptake is an independent risk factor for stroke, and patients with high RA SUVmax have a significantly higher risk of stroke. Moreover, RA FDG uptake improves prediction of stroke above the CHA2DS2-VASc score in patients with AF.

Cryptogenic stroke in atrial fibrillation without intra-heart thrombi: possible mechanisms

Background. Up to 45% of ischemic strokes are cryprogenic.Aim is to study which variant of permanent AF without intra-heart thrombi is the most unfavorable in appearing of stroke.Methods. We observed 202 patients with permanent AF without intra-heart thrombi and hemodynamically not significant carotid bifurcation atherosclerotic stenosis. We performed echocardiography, 24-hours monitoring of electrocardiography (ECG), ultrasound of brachiocephalic arteries, sphygmography of common carotid arteries, computer tomography of the brain, hemostasiograms, lipid profile, hemoglobin A1c. According to the 24-hours ECG monitoring data, we divided patients into two groups up to the maximum pauses between ventricular complexes in AF: patients with a pause &lt;1,5 seconds (113); ≥1,5 seconds (89). Both groups were on the same standard therapy including novel oral anticoagulants. We observed the patients during 1 year to analyze the verified stroke or transient ischemic attack (TIA).Results. In ultrasound, there was an increase of linear blood flow velocity in the area of carotid stenosis during the spread of the pulse wave after the long pause between ventricular contractions in group 2 up to 2,5 m/sec as in hemodynamically significant stenosis. In 1-year observation, there was the higher stroke in group 2.Conclusion. The appearance of stroke and TIA in AF is higher in patients who have 1,5 seconds and more of maximum duration pauses between ventricular contractions. The reason of cryptogenic stroke can be the atherosclerotic plaque defragmentation with further embolism, caused by additional mechanical impact of increased hemodynamical parameters of pulse wave after long pause between ventricular contractions.

Review of time in therapeutic range of warfarin in a tertiary centre in Malaysia

Anticoagulation management is a recognized challenge in medical care. Complications of supratherapeutic anticoagulation are hemorrhagic stroke, major bleeding, and death. There is an even greater risk of ischemic stroke in AF, worsening of VTE associated with subtherapeutic dosing.

Atrial Fibrosis, Ischaemic Stroke and Atrial Fibrillation.

Atrial fibrosis is an important component of the arrhythmic substrate in AF. Evidence suggests that atrial fibrosis also plays a role in increasing the risk of stroke in patients with the arrhythmia. Patients with embolic stroke of undetermined source (ESUS), who are suspected to have AF but are rarely shown to have it, frequently demonstrate evidence of atrial fibrosis; measured using late-gadolinium enhancement MRI, this manifests as atrial remodelling encompassing structural, functional and electrical properties. In this review, the authors discuss the available evidence linking atrial disease, including fibrosis, with the risk of ischaemic stroke in AF, as well as in the ESUS population, in whom it has been linked to recurrent stroke and new-onset AF. They also discuss the implications of this association on future research that may elucidate the mechanism of stroke and stroke prevention strategies in the AF and ESUS populations.

Abstract 11872: Use of Dronedarone and Periprocedural Stroke Risk in Patients Undergoing Catheter Ablation for Atrial Fibrillation

Introduction: Dronedarone was introduced as a promising Amiodarone-analogue with a good safety profile and comparing efficacy. Because of a two-fold increase in all-cause death, stroke, myocardial infarction, and hospitalization in permanent AF, recommendations regarding the use of dronedarone therapy are limited. We aimed to evaluate the risk of periprocedural thromboembolic events (TE) in a group of patients who underwent catheter ablation for AF under on-going dronedarone therapy. Methods: We retrospectively studied 2254 AF cases who underwent catheter ablation between Jan 2011 and May 2017. A group of 145 cases out of the above cohort (mean age 65 yrs; male 54%; CHADSVASc &gt;2 on 51% of the cases; Persistent AF 21%) was under dronedarone at the time of catheter ablation. We compared the dronedarone (DG) vs non-dronedarone group (nDG) in terms of periprocedural TE, specifically transient ischemic attack and stroke. To assess the impact of other possible explanatory variables we performed a multivariate regression analysis with interaction terms. All patients were under optimal oral anticoagulation at the time of catheter ablation. Results: DG showed a significantly higher frequency of 2,06 % periprocedural TE compared to 0.5% in nDG (p=0,024). Significant predictors of TE in DG were found to be age (OR 2,7 p=0,036), persistent AF (OR 3,6 p=0,036), NYHA class at the time of catheter ablation (OR 2,35 p=0,006) and left ventricular systolic function (OR 1,37 p= 0,05).Intraprocedural median ACT (OR 1,04 p=0,024) and electrical cardioversion (OR 10,3 p= 0,003) were the two significant intraprocedural predictors for stroke among patients on Dronedarone at the time of pulmonary vein isolation. Not predictive for periprocedural stroke were the type of catheter ablation technique, gender, HASBLEED score and spontaneous echo contras in left atrium. There was a significantly higher risk of stroke in DG patients under Phenprocoumon vs the ones on NOACs (OR 6, p= 0,047). CHADSVasc &gt; 2 showed a trend in increasing the risk for stroke among DG patients (OR 3,1 p=0,07). Conclusions: Dronedarone therapy is associated with an increased risk for stroke in patients undergoing catheter ablation, with higher risk among the elderly, persistent AF, and heart failure patients.

Routine podiatry assessment as a potential preventive tool for atrial fibrillation screening in diabetics

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Atrial fibrillation (AF) is a common heart arrhythmia predominantly in advanced age patients and in diabetic’s type II (DMPII). Even if the risk of stroke in AF in DMPII is relative high, 25% of AF patients remains undiagnosed and also cryptogenic AF is very common in the diabetic population. During a 12-month study project, podiatrists and podologists performed foot pulse-checks in their routine podiatry assessment, when encountering visual symptoms that suggest an underlying circulatory disorder in diabetics. This simple non-invasive method aims to increase screening and diagnosis of AF from allied health professionals, in order to reveal patients with previously undiagnosed AF and patients with cryptogenic Af, challenging the potential reduction of AF complications and mainly of stroke. Purpose Early detection of AF in diabetics from allied health professionals during routine podiatry assessment. Revealing of previously undiagnosed AF contributes to stroke and other AF complications incidence reduction in the diabetics population. Methods During a 12-month study, 2 podiatrists and 6 podologists performed foot pulse-checks on diabetics, during their annual foot screening appointments, since they have been trained from medical doctors to spot rhythm abnormalities during pulse palpation of the foot arteries. They have been also trained to confirm their pulse palpation evidence thought Doppler ultrasound wave assessments during evaluation of arterial blood supply (anterior-posterior tibial arteries and ramifications) of the diabetic foot. During the study 300 diabetics (mean age 60 years old, 180 males, 120 females) had their feet pulse-tested. Spss statistical software had been used. Results 17% of diabetics during foot pulse-checks presents undiagnosed AF. There was no statistically significant difference (p &amp;lt; 0.05) between sex (males and females AF screening percents were similar). Conclusion(s) Early detection and properly managed during AF screening reduces AF complications and specifically stroke incidence. Opportunistic podiatric detection of previously undiagnosed and cryptogenic AF from allied professionals is a non invasive, safe, fast and economic method with potential contributions in this direction. More studies must be designed in order to support the routine podiatry assessment, as a useful Screening diagnostic tool of AF for reducing cardiovascular complications incidence in diabetics but also in the general population.

Stroke Prevention in Patients with Atrial Fibrillation in Real Clinical Practice, Emphasis on Efficacy and Safety of Anticoagulant Therapy

Aim To evaluate frequency of administration of anticoagulant therapy (ACT) for atrial fibrillation and to study the effect of chronic antithrombotic therapy (ATT) on kidney function.Material and methods Due to a high medical and social significance of AF, much attention is presently paid to appropriate administration of ACT for AF in clinical practice. The study retrospectively analyzed 776 case reports of hospitalized patients with AF. The effect of chronic ATT on kidney function was studied in 70 patients who were rehospitalized, including 25 patients treated with warfarin, 25 patients treated with direct oral anticoagulants (DOAC), and 20 patients treated with acetylsalicylic acid (ASA).Results In January 2014, at the prehospital stage, 74.3 % of patients did not receive ATT, 14.7 % of patients received antiplatelet therapy, and only 11 % received anticoagulants. In the hospital in January 2014, ACTs were administered to 74.3 % of patients (warfarin, 58.6 %; DOAC, 15.7 %), 20.6 % of patients received antiplatelet drugs, and 5.1 % of patients were discharged without ATT. In January 2019, the number of patients receiving ACT at the prehospital stage increased to 58.1 % (warfarin, 13.8 %; DOAC, 44.3 %); 12 % of patients received antiplatelet drugs; and 29.9 % of patients did not receive ATT. The number of patients treated with warfarin and DOAC in the hospital increased to 14.8 % and 70.6 % (rivaroxaban, 33.4 %; apixaban, 25.5 %, and dabigatran, 11.7 %), respectively. The number of patients taking antiplatelet drugs decreased to 3.7 %, and the number of patients without ATT decreased to 10.9 %. There were no statistically significant differences in glomerular filtration rate (GFR) between these three groups at baseline. Only in the warfarin treatment group, GFR was significantly decreased from baseline during the follow-up period. Comparison of GFR in three study groups at the finale stage of the study showed significant differences between mean GFRs in the warfarin treatment group and the DOAC treatment group and between the warfarin treatment group and the ASA treatment group.Conclusion Among the prescribed and taken anticoagulants, DOACs are presently in the first place. Among DOACs, the most frequently prescribed drug is rivaroxaban. GFR decreases with the DOAC treatment slower than with the warfarin treatment. Despite the slower decrease in GFR with the ASA treatment compared to warfarin, ASA is not indicated for prevention of stroke in AF due to its low efficacy.

Cessation of oral anticoagulation is an important risk factor for stroke and mortality in atrial fibrillation patients.

Oral anticoagulation (OAC) is highly effective preventing stroke and mortality in AF, but withdrawal is common in the elderly, when high bleeding risk and when are difficulties achieving an optimal time in therapeutic range (TTR). We analysed the rate of OAC cessation, predisposing factors to cessation and the relation to clinical outcomes in a large 'real world' cohort of AF patients over a long follow-up period. Consecutive non-valvular AF outpatients clinically stables for six months were recruited. Rates of cardiovascular events, major bleeding and mortality were recorded and related to OAC cessation. We included 1361 patients (48.7 % male; aged 76, IQR 71-81), followed-up for a median of 6.5 years. During follow-up, 244 patients suffered thrombotic events, 250 suffered from major bleeding and 551 patients died. 10 % of patients stopped OAC. After OAC withdrawal, there were 36 thromboembolic events (22 strokes), 10 major bleedings and 75 deaths. OAC cessation was independently associated with adverse cardiovascular events (HR 1.45; 95 % CI 1.01-2.08), stroke/TIA (HR 1.85; 1.17-2.94) and all-cause mortality (HR 1.30; 1.02-1.67). Independent predictors of OAC cessation were age ≥80 (HR 2.29; 1.60-3.29), previous coronary artery disease (HR 0.32; 0.15-0.71), major bleeding (HR 5.00; 3.49-7.15), heart failure (HR 2.38; 1.26-4.47), cancer (HR 5.24; 3.25-8.44) and renal impairment developed during follow-up (HR 2.70; 1.26-5.75). In conclusion, in non-valvular AF patients, cessation of OAC was independently associated with the risk of stroke, adverse cardiovascular events and mortality. Bleeding events and some variables associated with higher bleeding risk are responsible for OAC cessation.

Association of BW with Thromboembolic and Bleeding Outcomes in Phase III Randomized Controlled Trials of Direct Oral Anticoagulants: Systematic Review and Meta-Analysis

Association of BW with Thromboembolic and Bleeding Outcomes in Phase III Randomized Controlled Trials of Direct Oral Anticoagulants: Systematic Review and Meta-Analysis

P2.9 - Anticoagulation For The Prevention of Stroke In Non-Vavular Af In General Practice: Room For Improvement

P2.9 - Anticoagulation For The Prevention of Stroke In Non-Vavular Af In General Practice: Room For Improvement

Advanced Left Atrial Remodeling and Appendage Contractile Dysfunction in Women Than in Men Among the Patients With Atrial Fibrillation: Potential Mechanism for Stroke.

BackgroundThe risk of stroke imposed by atrial fibrillation (AF) is significantly greater in women than men; however, the mechanism remains elusive. We hypothesized that left atrial (LA) remodeling and poor contractile function of LA appendage (LAA) would be more predominant in women than men among AF patients.Methods and ResultsA total of 579 AF patients (216 women vs age‐, AF type–, and incidences of heart failure, hypertension, diabetes mellitus, stroke or transient ischemic attack, and vascular disease–matched 363 men, 61.3±10.2 years old, 70.1% paroxysmal AF) who underwent AF catheter ablation were included. Sex differences in LA volume index (LAVI) and LAA emptying flow velocity (FV) were analyzed in risk factor 0, 1, and ≥2 groups, according to their CHA 2 DS 2‐VASc scores beyond sex category. LAA‐FV was more significantly reduced in women with risk factor ≥2 than in men of the same risk group (P=0.022). Women showed greater LAVI than their male counterparts in the risk factor ≥2 group (P<0.001). The majority of female patients with a history of stroke had a large LAVI and low LAA‐FV (P<0.001); however, no such distribution was observed in men (P=0.596). LA volume index (odds ratio [OR], 1.038; 95% CI, 1.003–1.075, P=0.035) or LAA‐FV (OR, 0.976; 95% CI, 0.952–0.999; P=0.047) was significantly associated with a history of stroke in women.ConclusionsMore‐extensive LA remodeling and deterioration in LAA function were noted in women than in men with high calculated risk of stroke in AF.

Anticoagulation for the prevention of stroke in non-valvular AF in general practice: room for improvement

Anticoagulation for the prevention of stroke in non-valvular AF in general practice: room for improvement

CLINICAL-GENETIC RISKOMETER FOR THE ISCHEMIC STROKE RISK ASSESSMENT IN ATRIAL FIBRILLATION

Aim. To assess genetic issues in the ischemic stroke development in AF and to invent an analytical programmed complex for genetic risk estimation of stroke development in a patient with AF. Material and methods. Totally 43 patients studied with AF and stroke in anamnesis, 78 — with AF and no stroke. Controls consisted of 188 persons without cardiovascular pathology. The participants underwent ECG, EchoCG, Holter ECG-monitoring, exercise test, TELAS, thyroid gland hormones analysis. For confirmation of the ischemic nature of stroke in participating probands we performed computed tomography of the brain. All participants also underwent molecular genetic testing. Results. According to the odds ratio, allele A polymorphism -455G&gt;A of gene FGB increases the risk of ischemic stroke development in atrial fibrillation 1,7 times comparing to those patients without the allele; genotypes with the rare T allele in homoand heterozygous state of polymorphism 807С&gt;Т of gene GPI? increases 2,5 times the risk of stroke in AF; presence of allele C polymorphism -5Т&gt;С of gene GPI?? increases 1,9 times the risk of stroke comparing to its absence; presence of the rare genotypes allele C in homoand heterozygous state -5Т&gt;С of gene GPI?? increases 2,3 times stroke risk; allele A of the polymorphism 10976G&gt;A gene FVII decreases the risk of stroke 2,6 times. According to the results, there was a “Clinical-genetic riskometer of the ischemic stroke in AF” developed. Using this informational-analytic complex it is possible to estimate genetic risk of the stroke. Conclusion. Therefore, the study has shown that homozygous genotype AA of the rare polymorphism 455G&gt;A gene FGB, heterozygous genotype СТ and homozygous genotype ТТ of the rare polymorphism allele 807С&gt;Т gene GPI?, heterozygous genotype TC and homozygous genotype CC by the rare allele polymorphism -5Т&gt;С gene GPI?? are defined as genetic predictors of ischemic stroke development in atrial fibrillation. Allele А of polymorphism 10976G&gt;A gene FVII is protective against ischemic stroke in patients with AF. Knowing the parameters of genetic assessment in AF, it is possible to calculate genetic risk of ischemic stroke development in AF via invented by us a “Clinical-Genetic riskometer of ischemic stroke in AF”.

Stroke in AF: Additional Risk Factors, OAC, and LAA Occlusion

Patients with atrial fibrillation are at increased risk of stroke, and the addition of a single risk factor indicates a need for prophylaxis with warfarin or a non-VKA oral anticoagulant. Left atrial appendage occlusion is a potential alternative if long-term anticoagulation is contraindicated.

Managing Antithrombotic Therapy in Patients With Both Atrial Fibrillation and Coronary Heart Disease

PurposeAtrial fibrillation (AF) and coronary heart disease (CHD) commonly occur together. Previous consensus guidelines were published before the wide availability of novel oral anticoagulants (NOACs) and newer P2Y12 antiplatelet agents. We examine recent evidence to guide management in 3 categories of patients with AF and CHD: patients with stable CHD, nonstented patients with recent acute coronary syndrome, and patients with a coronary stent requiring dual-antiplatelet therapy. MethodsWe conducted a literature search by evaluation of PubMed and other data sources including international meeting reports. We critically reviewed recent clinical trial and relevant registry evidence to update European and US consensus documents. FindingsOral anticoagulation with warfarin or NOACs is required to prevent embolic stroke in AF, and antiplatelet therapy is insufficient for this purpose. Antiplatelet therapy using monotherapy with aspirin is the standard of care in stable CHD. Dual-antiplatelet therapy with aspirin and clopidogrel or a new P2Y12 inhibitor (dual-antiplatelet therapy) is needed to reduce coronary events after an acute coronary syndrome or after percutaneous coronary intervention. Combinations of these agents increase the risk of bleeding, and limited clinical trial evidence suggests that withdrawal of aspirin may reduce bleeding without increasing coronary events. ImplicationsAvailable clinical trials and registries provide remarkably little evidence to guide difficult clinical decision making in patients with combined AF and CHD. In patients on triple antithrombotic therapy with vitamin K antagonists, aspirin, and clopidogrel, a single clinical trial indicates that withdrawal of aspirin may reduce bleeding risk without increasing the risk of coronary thrombosis. It is unclear whether this evidence applies to combinations of NOACs and newer P2Y12 inhibitors. Clinical trials of combinations of the newer antithrombotic agents are urgently needed to guide clinical care.

Aspirin to Prevent Stroke in AF Not Supported by Data

Aspirin to Prevent Stroke in AF Not Supported by Data

Preventing Stroke in AF: Current Issues

Preventing Stroke in AF: Current Issues

Abstract 314: Impact of Spontaneous Bleeding Events on Health State Utility in Patients with Atrial Fibrillation: Results from the ENGAGE AF-TIMI 48 Trial

BACKGROUND: Anticoagulation in AF patients involves consideration of the benefit of stroke risk reduction versus increased bleeding risk. The impact of bleeding events on health state utility has not been clearly understood. METHODS: We used prospectively-collected data from the ENGAGE AF-TIMI 48 Trial to estimate the impact of different bleeding events on utility scores derived from the EQ-5D. EQ-5D data were collected at randomization and 3 month intervals for up to 48 months; at least two EQ-5D assessments were available for 15,618 participants. Spontaneous bleeding events were identified prospectively and adjudicated according to prespecified criteria. Patients who experienced a bleed and provided at least one EQ-5D assessment before and after the event were included in the analysis. To maximize specificity, patients were excluded if they had more than 1 bleeding event or any other major cardiovascular events in addition to bleeding. Longitudinal growth curve models were used to estimate changes in utilities after the following mutually exclusive bleeding event categories: intracranial hemorrhage (ICH; n=25); major GI (n=294); major non-GI (n=236); clinically relevant non-major (CRNM) (n=1,414); and minor (n=783). RESULTS: There were reductions in EQ-5D utility after the event for all categories of bleeding that were in parallel with the severity of bleeding (Table). The estimated decrease in utility was greatest for ICH (-0.079), followed by major non-GI (–0.045), GI (–0.030) and CRNM (–0.009). In addition, a significant linear improvement over time was observed for major non-GI bleeds (and a similar albeit non significant improvement for major GI bleeds) such that EQ-5D scores returned to near pre-event levels one year after the bleeding event. No post-event improvement was observed for ICH, CRNM and minor bleeds, however. CONCLUSION: Spontaneous bleeding events are associated with a negative impact on health state utility, with greatest immediate impact for major bleeds. Health state utility remains low 1 year after an ICH, but gradually returns to baseline 1-year after other major bleeding events. Future cost-effectiveness analysis of strategies to prevent stroke in AF should consider both the economic and health status impact of bleeding events to inform health care decision making.

Female sex as an independent risk factor for stroke in atrial fibrillation: Possible mechanisms

Atrial fibrillation (AF) is an independent risk factor for thromboembolism and stroke. Women with AF are at a higher overall risk for thromboembolic stroke when compared to men with AF. Recent evidence suggests that female sex, after adjusting for stroke risk profile and sex differences in utilisation of anticoagulation, is an independent stroke risk factor in AF. The inclusion of female sex has improved the accuracy of the CHADS2 stroke risk stratification schema (Congestive heart failure, Hypertension, Age 75 years or greater, Diabetes mellitus, and prior Stroke or TIA). The newly revised and validated schema, CHA2DS2-VASc, dichotomises age and incorporates female sex and vascular disease history. The pathophysiological mechanisms to explain this increased risk in women are not well understood. According to Virchow's triad, thrombosis that leads to stroke in AF should arise from three co-existing phenomena: structural abnormalities, blood stasis, and a hypercoagulable state. Herein, we explore the sex differences in the biological processes that lead to thrombus formation as applied to Virchow's Triad. The objective of this review is to describe the potential mechanisms behind the increased risk of stroke in AF associated with female sex.

Atrial fibrillation: Stroke prevention in focus

IntroductionAtrial fibrillation (AF) is a common arrhythmia and a risk factor for stroke and other, adverse events. Internationally there have been recent advancements in the therapies available for, stroke prevention in AF. Nurses will care for individuals with AF across a variety of primary and acute, care settings and should be familiar with evidence based therapies. AimThis paper provides a review of the epidemiology of AF and stroke, stroke and bleeding risk, assessment tools and evidence based treatments for the prevention of stroke in AF including the use of, novel anti-thrombin agents. MethodA review of key databases was conducted from 2002 to 2012 using the key search terms ‘atrial, fibrillation’ ‘anticoagulation’ ‘risk assessment’ and ‘clinical management’. The following electronic, databases were searched: CINAHL, Medline, Scopus, the Cochrane Library and Google Scholar., Reference lists were manually hand searched. Key clinical guidelines from National Institute for, Clinical Excellence (NICE, UK), American Heart Association (AHA, USA), American College of Cardiology, (ACC, USA) and the European Society of Cardiology (ESC) and key government policy documents were, also included. Articles were included in the review if they addressed nursing management with a focus, on Australia. ResultsMany treatment options exist for AF. Best practice guidelines make a variety of, recommendations which include cardioversion, ablation, pulmonary vein isolation, pharmacological, agents for rate or rhythm control approaches, and antithrombotic therapy (including anticoagulation, and antiplatelet therapy). Treatment should be patient centred and individualised based upon, persistency of the rhythm, causal nature, risk and co-morbid conditions. ConclusionAF is a common and burdensome condition where treatment is complex and not without, risk. Nurses will encounter individuals with AF across a variety of primary and acute care areas, understanding the risk of AF and appropriate therapies is important across all care settings. Treatment, must be individually tailored to the needs of the patient and balanced with the best available evidence.