Stroke Prevention in Atrial Fibrillation
Despite the evidence-based guidelines for the management of atrial fibrillation (AF), serious gaps continue to exist between clinical knowledge and practice, leaving patients at risk for disabling strokes. It is estimated that up to 67% of AF-related strokes are preventable. The significant increase in mortality and functional impairment is even more alarming, compared to non-AF strokes.
Updated AF treatment guidelines recommend new oral anticoagulants (NOACs) over warfarin for stroke prevention except, in patients with moderate to severe mitral stenosis or a mechanical heart valve. Based on some recent trials, NOACs were superior to warfarin for the prevention of the composite of stroke and systemic embolism in patients with AF and an additional risk factor for stroke. Reversal agents are now also available for NOACs in patients for severe bleeding or emergency procedures.
With the increased utilization of NOACs, it is critical for the clinician to understand the clinical and practical usage of these agents in diverse patient populations and clinical situations.
In this section
Radcliffe Cardiology would like to thank Boehringer Ingelheim for their support in the development of this section.

Section advisor
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Videos
Video Series
RE-DUAL PCI – In ReviewVideos
Video Series
Anticoagulation in AF Following PCIVideo Series
RE-DUAL PCI – In ReviewVideo Series
AER: LIVE 2019Video
RE-DUAL PCIVideo
HRS 2019: CAPTURE TrialVideo
AHA 2018: AF-ALERT TrialFeatured Articles 
Clinical publications
Glund S, Gan G, Moschetti V, et al. Clin Appl Thromb Hemost 2018;24:724–33.
Med Lett Drugs Ther 2018;60:99–101.
Själander S, Sjögren V, Renlund H, et al. Thromb Res 2018;167:113–8.
McAllister DA, Read SH, Kerssens J, et al. Circulation 2018;138:2774–86.
Lee CJ, Gerds TA, Carlson T, et al. J Am Coll Cardiol 2018;72:17–26.
Lane DA, Meyerhoff J, Rohner U, Lip GYH. Clin Cardiol 2018;41:855–61.
Andrade JG, Hawkins NM, Fordyce CB, al. Can J Cardiol 2018;34:1010–8.
Chen N, Lutsey PL, MacLehose RF, et al. J Am Heart Assoc 2018;7:e009561.
Mentias A, Briasoulis A, Shantha G, et al. Am J Cardiol 2019;123:P1649–53.
Limeres J, Lip GYH, Del Blanco BG, et al. Thromb Res 2019;177:180–6.
Fauchier L, Blin P, Sacher F, et al. Europace 2020;22:205–15.
Jackson LR 2nd, Kim S, Blanco R, et al. Am Heart J 2020;226:85–93.
Garcia DA, Fisher DA, Mulder H, et al. Am Heart J 2020;221:1–8.
Potpara TS, Lip GYH, Dagres N, et al. Eur Heart J Qual Care Clin Outcomes 2020; epub ahead of press.
Dong SJ, Wu B, Zhai SD, et al. Clin Ther 2020;42:144–56.E1.
Yang L, Brooks MM, Glynn NW, et al. Am J Cardiol 2020;126:29–36.
Wang SY and Giugliano RP. Am J Cardiol 2020;127:176–83.
Paquette M, França LR, Teutsch C, et al. Am J Cardiol 2020;125:383–91.
Jansson M, Själander S, Sjögren V, et al. Thromb Res 2020;185:135–41.
Krittayaphong R, Chantrarat T, Rojjarekampai R, et al. J Clin Med 2020;9:e1698.
Blin P, Dureau-Pournin C, Bénichou J, et al. Am J Cardiovasc Drugs 2020;20:81–103.
Meyre P, Aeschbacher S, Blum S, et al. Eur J Prev Cardiol 2020; epub ahead of press.
Yasaka M, Uchiyama S, Atarashi H, et al. J Stroke Cerebrovasc Dis 2020;29:104717.
Atar D, Berge E, Le Heuzey JY, et al. Europace 2020;22:195–204.
Ma C, Riou França L, Lu S, et al. J Arrhythm 2020;36:408–16.
Maggioni AP, Dondi L, Andreotti F, et al. Am Heart J 2020;220:12–9.
Guidelines
Seferović PM, Petrie MC, Filippatos GS, et al. Eur J Heart Fail 2018;20:853–72.
Steffel J, Verhamme P, Potpara TS, et al. Eur Heart J 2018;39:1330–93.
Dan GA, Iliodromitis K, Scherr D, et al. Europace 2018;20:1382–7.
Gorenek B, Halvorsen S, Kudaiberdieva G, et al. Eur Heart J Acute Cardiovasc Care 2020; epub ahead of press.
Messé SR, Gronseth GS, Kent DM, et al. Neurology 2020;94:876–85.
Chung MK, Eckhardt LL, Chen LY, et al. Circulation 2020;141:e750–e772.
Skurk C and Landmesser U. EuroIntervention 2020;15:1117–9.
Opinion articles
Di Biase L, Romero J. JACC Clin Electrophysiol 2018;4:601–3.
Nassif ME, Kosiborod M. Circulation 2018;138:4–6.
Hohnloser SH, Eikelboom JW. J Am Coll Cardiol 2018;72:27–8.
Pokorney SD, Lopes RD. Heart 2019;105:848–54.
Khaji A, Hanley C, Kowey PR. Cardiol Clin 2019;37:197–206.
Byrne RA, Colleran R, Kastrati A. EuroIntervention 2019;14:e1793–5.
Belley-Cote EP and Eikelboom JW. JAMA Netw Open 2020;3:e202237.
Packer M. Europace 2020;22:681–3.
Potpara TS, Mujovic N and Lip GYH. Europace 2020;22:173–6.
Brand-McCarthy SR, Delaney RK and Noseworthy PA. Circ Cardiovasc Qual Outcomes 2020;13:e006080.
Kawakami S, Yasuda S and Ogawa H. J Cardiol 2020;76:35–43.
Mulder BA, ten Berg J, ten Cate H, et al. Neth Heart J 2020.
Review articles
European Cardiology Review 2019;14(2):103–10
Patti G, Cavallari I, Hanon O, De Caterina R. Int J Cardiol 2018;265:118–24.
Ha ACT, Verma A, Mazer CD, et al. Curr Opin Cardio 2019;34:140–6.
Chan NC, Eikelboom JW. Blood 2019;133:2269–78.
Ng SS, Lai NM, Nathisuwan S, et al. Sci Rep 2020;10:662.
Xu D, Su C and Pan J. Curr Drug Metab 2020;21:106–11.
Jin H, Zhu K, Wang L, et al. Cardiovasc Ther 2020;2020:2683740.
Kido K, Lee JC, Hellwig T, Gulseth MP. Pharmacotherapy 2020;40:72–83.
Schäfer A, Flierl U, Berliner D and Bauersachs J. Cardiovasc Drugs Ther 2020;34:555–68.
Liu X, Xu ZX, Yu P, et al. Cardiovasc Drugs Ther 2020;34:569–78.
Smythe MA, Parker D, Garwood CL, et al. Pharmacotherapy 2020;40:55–71.
Ferrari F, da Silveira AD, Martins VM, et al. Cardiol Rev 2020.
Trials
Yanagisawa S, Inden Y, Fujii A, et al. JACC Clin Electrophysiol 2018;4:592–600.
Figtree GA, Rådholm K, Barrett TD, et al. Circulation 2019;139:2591–3.
Verma S, McMurray JJV. Circulation 2019;139:2537–41.
Madhavan M, Holmes DN, Piccini JP et al. Am Heart J 2019;211:77–89.
Lip GHY, Mauri L, Montalescot G, et al. Am Heart J 2019;212:13–22.
Calkins H, Willems S, Verma A, et al. EP Europace 2019;21:879–85
Anguita Sánchez M, Bertomeu Martínez V, Ruiz Ortiz M, et al. Rev Esp Cardiol (Engl Ed) 2020;73:14–20.
Russo V, Attena E, Rago A, et al. J Clin Med 2020;9:1621.
Wongcharoen W, Pacharasupa P, Norasetthada L, et al. Circ J 2020;84:1075–82.
Van Ganse E, Danchin N, Mahé I, et al. Stroke 2020;51:2066–75.
Glund S, Gan G, Moschetti V, et al. Clin Appl Thromb Hemost 2018;24:724–33.
Med Lett Drugs Ther 2018;60:99–101.
Själander S, Sjögren V, Renlund H, et al. Thromb Res 2018;167:113–8.
McAllister DA, Read SH, Kerssens J, et al. Circulation 2018;138:2774–86.
Lee CJ, Gerds TA, Carlson T, et al. J Am Coll Cardiol 2018;72:17–26.
Lane DA, Meyerhoff J, Rohner U, Lip GYH. Clin Cardiol 2018;41:855–61.
Andrade JG, Hawkins NM, Fordyce CB, al. Can J Cardiol 2018;34:1010–8.
Chen N, Lutsey PL, MacLehose RF, et al. J Am Heart Assoc 2018;7:e009561.
Mentias A, Briasoulis A, Shantha G, et al. Am J Cardiol 2019;123:P1649–53.
Limeres J, Lip GYH, Del Blanco BG, et al. Thromb Res 2019;177:180–6.
Fauchier L, Blin P, Sacher F, et al. Europace 2020;22:205–15.
Jackson LR 2nd, Kim S, Blanco R, et al. Am Heart J 2020;226:85–93.
Garcia DA, Fisher DA, Mulder H, et al. Am Heart J 2020;221:1–8.
Potpara TS, Lip GYH, Dagres N, et al. Eur Heart J Qual Care Clin Outcomes 2020; epub ahead of press.
Dong SJ, Wu B, Zhai SD, et al. Clin Ther 2020;42:144–56.E1.
Yang L, Brooks MM, Glynn NW, et al. Am J Cardiol 2020;126:29–36.
Wang SY and Giugliano RP. Am J Cardiol 2020;127:176–83.
Paquette M, França LR, Teutsch C, et al. Am J Cardiol 2020;125:383–91.
Jansson M, Själander S, Sjögren V, et al. Thromb Res 2020;185:135–41.
Blin P, Dureau-Pournin C, Bénichou J, et al. Am J Cardiovasc Drugs 2020;20:81–103.
Krittayaphong R, Chantrarat T, Rojjarekampai R, et al. J Clin Med 2020;9:e1698.
Yasaka M, Uchiyama S, Atarashi H, et al. J Stroke Cerebrovasc Dis 2020;29:104717.
Meyre P, Aeschbacher S, Blum S, et al. Eur J Prev Cardiol 2020; epub ahead of press.
Ma C, Riou França L, Lu S, et al. J Arrhythm 2020;36:408–16.
Atar D, Berge E, Le Heuzey JY, et al. Europace 2020;22:195–204.
Maggioni AP, Dondi L, Andreotti F, et al. Am Heart J 2020;220:12–9.
Seferović PM, Petrie MC, Filippatos GS, et al. Eur J Heart Fail 2018;20:853–72.
Steffel J, Verhamme P, Potpara TS, et al. Eur Heart J 2018;39:1330–93.
Dan GA, Iliodromitis K, Scherr D, et al. Europace 2018;20:1382–7.
Gorenek B, Halvorsen S, Kudaiberdieva G, et al. Eur Heart J Acute Cardiovasc Care 2020; epub ahead of press.
Messé SR, Gronseth GS, Kent DM, et al. Neurology 2020;94:876–85.
Chung MK, Eckhardt LL, Chen LY, et al. Circulation 2020;141:e750–e772.
Skurk C and Landmesser U. EuroIntervention 2020;15:1117–9.
Di Biase L, Romero J. JACC Clin Electrophysiol 2018;4:601–3.
Nassif ME, Kosiborod M. Circulation 2018;138:4–6.
Hohnloser SH, Eikelboom JW. J Am Coll Cardiol 2018;72:27–8.
Pokorney SD, Lopes RD. Heart 2019;105:848–54.
Khaji A, Hanley C, Kowey PR. Cardiol Clin 2019;37:197–206.
Byrne RA, Colleran R, Kastrati A. EuroIntervention 2019;14:e1793–5.
Belley-Cote EP and Eikelboom JW. JAMA Netw Open 2020;3:e202237.
Packer M. Europace 2020;22:681–3.
Potpara TS, Mujovic N and Lip GYH. Europace 2020;22:173–6.
Brand-McCarthy SR, Delaney RK and Noseworthy PA. Circ Cardiovasc Qual Outcomes 2020;13:e006080.
Kawakami S, Yasuda S and Ogawa H. J Cardiol 2020;76:35–43.
Mulder BA, ten Berg J, ten Cate H, et al. Neth Heart J 2020.
European Cardiology Review 2019;14(2):103–10
Patti G, Cavallari I, Hanon O, De Caterina R. Int J Cardiol 2018;265:118–24.
Ha ACT, Verma A, Mazer CD, et al. Curr Opin Cardio 2019;34:140–6.
Chan NC, Eikelboom JW. Blood 2019;133:2269–78.
Ng SS, Lai NM, Nathisuwan S, et al. Sci Rep 2020;10:662.
Xu D, Su C and Pan J. Curr Drug Metab 2020;21:106–11.
Jin H, Zhu K, Wang L, et al. Cardiovasc Ther 2020;2020:2683740.
Kido K, Lee JC, Hellwig T, Gulseth MP. Pharmacotherapy 2020;40:72–83.
Schäfer A, Flierl U, Berliner D and Bauersachs J. Cardiovasc Drugs Ther 2020;34:555–68.
Liu X, Xu ZX, Yu P, et al. Cardiovasc Drugs Ther 2020;34:569–78.
Smythe MA, Parker D, Garwood CL, et al. Pharmacotherapy 2020;40:55–71.
Ferrari F, da Silveira AD, Martins VM, et al. Cardiol Rev 2020.
Yanagisawa S, Inden Y, Fujii A, et al. JACC Clin Electrophysiol 2018;4:592–600.
Figtree GA, Rådholm K, Barrett TD, et al. Circulation 2019;139:2591–3.
Verma S, McMurray JJV. Circulation 2019;139:2537–41.
Madhavan M, Holmes DN, Piccini JP et al. Am Heart J 2019;211:77–89.
Lip GHY, Mauri L, Montalescot G, et al. Am Heart J 2019;212:13–22.
Calkins H, Willems S, Verma A, et al. EP Europace 2019;21:879–85
Anguita Sánchez M, Bertomeu Martínez V, Ruiz Ortiz M, et al. Rev Esp Cardiol (Engl Ed) 2020;73:14–20.
Russo V, Attena E, Rago A, et al. J Clin Med 2020;9:1621.
Wongcharoen W, Pacharasupa P, Norasetthada L, et al. Circ J 2020;84:1075–82.
Van Ganse E, Danchin N, Mahé I, et al. Stroke 2020;51:2066–75.