Cardiovascular Innovations and Applications (Jan 2016)

Stroke Prevention in Atrial Fibrillation: Current Strategies and Recommendations

  • Gerald V. Naccarelli,
  • Gregory Caputo,
  • Thomas Abendroth,
  • Samuel Faber,
  • Mauricio Sendra-Ferrer,
  • Deborah Wolbrette,
  • Soraya Samii,
  • Sarah Hussain,
  • Mario Gonzalez

DOI
https://doi.org/10.15212/CVIA.2016.0005
Journal volume & issue
Vol. 1, no. 2
p. 157

Abstract

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Stroke is the most common complication of atrial fibrillation (AF). Guidelines recommend anticoagulant treatment in patients with CHA2DS2VASc scores of >2. Registry data suggests that almost half of patients who should be on therapeutic anticoagulation for stroke prevention in AF (SPAF) are not. Warfarin and more recently developed agents, the “novel anticoagulants” (NOACs) reduce the risk of embolic strokes. In addition, the NOACs also reduce intracranial hemorrhage (ICH) by over 50% compared to warfarin. Anticoagulation and bridging strategies involving cardioversion, catheter ablation, and invasive/surgical procedures are reviewed. The development of reversal agents for NOACs and the introduction of left atrial appendage occluding devices will evolve the use of newer strategies for preventing stroke in high risk AF patients.