Antithrombotic therapy for stroke prevention in non-valvular atrial fibrillation

Summary The world faces an epidemic of atrial fibrillation and atrial fibrillation-related stroke. An individual's risk of atrial fibrillation-related stroke can be estimated with the CHADS2 or CHA2 DS2 VASc scores, and reduced by two-thirds with effective anticoagulation. Vitamin K antagonists...

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Bibliographic Details
Published in:Lancet neurology 2012-12, Vol.11 (12), p.1066-1081
Main Authors: Alberts, Mark J, Prof, Eikelboom, John W, FRACP, Hankey, Graeme J, Prof
Format: Article
Language:English
Subjects:
Administration, Oral
Animals
Antagonists
Anticoagulants
Anticoagulants - administration & dosage
Anticoagulants - adverse effects
Antidotes
Aspirin
Atrial Fibrillation - drug therapy
Atrial Fibrillation - epidemiology
Bleeding
Cardiac arrhythmia
Clinical Trials as Topic - methods
Diabetes
Drug interaction
Epidemics
Fibrillation
Fibrinolytic Agents - administration & dosage
Fibrinolytic Agents - adverse effects
Glycoproteins
Heart failure
Heart Valves - physiology
Hemorrhage
Hemorrhage - chemically induced
Hemorrhage - epidemiology
Hemorrhage - prevention & control
Humans
Hypertension
Ischemia
Neurology
Stroke
Stroke - epidemiology
Stroke - prevention & control
Thrombin
Thromboembolism
Transient ischemic attack
Treatment Outcome
Vitamin K
Warfarin
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Summary:Summary The world faces an epidemic of atrial fibrillation and atrial fibrillation-related stroke. An individual's risk of atrial fibrillation-related stroke can be estimated with the CHADS2 or CHA2 DS2 VASc scores, and reduced by two-thirds with effective anticoagulation. Vitamin K antagonists, such as warfarin, are underused and often poorly managed. The direct thrombin inhibitor dabigatran etexilate and factor Xa inhibitors rivaroxaban and apixaban are new oral anticoagulants that are at least as efficacious and safe as warfarin. Their advantages are predictable anticoagulant effects, low propensity for drug interactions, and lower rates of intracranial haemorrhage than with warfarin. A disadvantage is the continuing need to develop and validate rapidly effective antidotes for major bleeding and standardised tests that accurately measure plasma concentrations and anticoagulant effects, together with the disadvantage of possible higher rates of gastrointestinal haemorrhage and greater expense than with warfarin. The new oral anticoagulants should increase the number of patients with atrial fibrillation at risk of stroke who are optimally anticoagulated, and reduce the burden of atrial fibrillation-related stroke.
ISSN:1474-4422
1474-4465
DOI:10.1016/S1474-4422(12)70258-2