Stroke Prevention in Atrial Fibrillation

Literature review: stroke prevention in atrial fibrillation

The review includes the pivotal randomised controlled trials for warfarin and direct oral anticoagulants as well as relevant publications from the last 18 months. The following search terms were used: ‘stroke prevention’, ‘atrial fibrillation’, dabigatran, rivaroxaban, apixaban, edoxaban, warfarin, ‘oral anticoagulants’, ‘non-VKA oral anticoagulants’, novel oral anticoagulants’, ‘direct oral anticoagulants’, ‘reversal agents’

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Key Articles

Independent Medical Education

Guidelines/ Expert Recommendations

Randomised Controlled Trials

Post-Hoc/Subgroup Analysis Of Pivotal Trials - Dabigatran

Post-Hoc/Subgroup Analysis Of Pivotal Trials - Edoxaban

Post-Hoc/Subgroup Analysis Of Pivotal Trials - Apixaban

Post-Hoc/Subgroup Analysis Of Pivotal Trials - Diabetes

Post-Hoc/Subgroup Analysis Of Pivotal Trials - Elderly

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.

Radcliffe Cardiology would like to thank Boehringer Ingelheim for their support in the development of this section.

Boehringer Ingelheim

Content on this section was partly provided by Boehringer Ingelheim. For any follow up questions please contact your local Boehringer Ingelheim representative.

  • Heparin dosing in uninterrupted anticoagulation

    This study also suggests that the heparin units required to reach the desired ACT may be affected by the time from the last preprocedural dose of dabigatran.

    AIMS: To describe heparin dosing requirements in patients who...

    Calkins H, Willems S, Verma A, et al. EP Europace 2019;21:879–85
  • Anticoagulant therapy in older individuals with atrial fibrillation or venous thromboembolism

    In this review, the authors illustrate common challenges with anticoagulant use in older patients by describing five clinical cases and discussing how they decide upon the most appropriate antithrombotic therapy in those clinical situations....

    Chan NC, Eikelboom JW. Blood 2019;133:2269–78.
  • Atrial Fibrillation Ablation

    Heart failure (HF) and atrial fibrillation (AF) are the epidemics of the twenty-first century. These often coexist and are the cause of major morbidity and mortality. Management of these patients has posed a significant challenge to the medical...

    Khaji A, Hanley C, Kowey PR. Cardiol Clin 2019;37:197–206.
  • The Serendipitous Story of SGLT2

    The authors of this editorial refer to the latest publications from DECLARE-TIMI 58 and the CANVAS Program.

    Diabetes intersects with cardiovascular disease at every level. While there has been much focus on understanding atherosclerotic...

    Verma S, McMurray JJV. Circulation 2019;139:2537–41.
  • Effect of Dapagliflozin on Heart Failure

    In DECLARE-TIMI 58, the sodium glucose co-transporter 2 inhibitor (SGLT2i) dapagliflozin reduced the composite endpoint of cardiovascular (CV) death/ hospitalization for heart failure (HHF) in a broad population of patients with T2DM.


    Kato ET, Silverman MG, Mosenzon O, et al. Circulation 2019;139:2528–36.

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