Stroke prevention in atrial fibrillation

Lopes RD, Crowley MJ, Shah BR, Melloni C, Wood KA, Chatterjee R, Povsic TJ, Dupre ME, Kong DF, Barros e Silva PGM, Santos MHH, Armaganijan LV, Katz M, Kosinski A, McBroom AJ, Chobot MM, Gray R, Sanders GD
Record ID 32011001373
Authors' objectives: Oral anticoagulation with vitamin K antagonists (VKAs) has long been the gold standard therapy for stroke prevention in nonvalvular atrial fibrillation (AF). Limitations in monitoring and compliance of VKAs have fueled the development of new antithrombotic strategies, devices, and oral anticoagulants, including oral direct thrombin inhibitors and factor Xa inhibitors. This review updates previous reviews, particularly with regard to these newer treatment options and the optimal risk stratification tools for stroke and bleeding prediction.
Authors' recommendations: Overall, we found that CHADS2 and CHA2DS2-VASc scores have the best discrimination ability for stroke events in patients with AF among the risk scores we reviewed, whereas HAS-BLED provides the best discrimination of bleeding risk. Imaging tools require further evidence in regard to their appropriate use in clinical decisionmaking. Improved evidence of the use of these scores among patients on therapy is also required. Newer anticoagulants show early promise of reducing stroke and bleeding events when compared with warfarin, and apixaban shows safety and efficacy in patients who are not candidates for warfarin. However, further studies are required for key clinical scenarios involving anticoagulation use and procedures, switching or bridging therapies, and when to start anticoagulation after a hemorrhagic event.
Project Status: Completed
Year Published: 2013
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: United States
MeSH Terms
  • Anticoagulants
  • Atrial Fibrillation
  • Platelet Aggregation Inhibitors
  • Thromboembolism
  • Warfarin
  • Stroke
Organisation Name: Agency for Healthcare Research and Quality
Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;
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Copyright: <p>Agency for Healthcare Research and Quality (AHRQ)</p>
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