Oral anticoagulant use for stroke prevention in atrial fibrillation patients with difficult scenarios

Abstract

Atrial fibrillation (AF) has become the most prevalent arrhythmia and it will increase the risk of ischemic stroke, heart failure, mortality, sudden cardiac death, myocardial infarction, and dementia. Stroke prevention with oral anticoagulant is crucial for management of AF patients. Vitamin K antagonist, which inhibits the clotting factors II, VII, IX and X, has been recommended for stroke prevention for decades. Non-Vitamin K antagonist oral anticoagulants (NOACs), including dabigatran, rivaroxaban, apixaban and edoxaban are at least as effective as warfarin in reducing ischemic stroke with a lower rate of major bleeding. With the increasing prevalence of AF, prescription of the appropriate oral anticoagulants (OACs) according to patient's characteristics becomes a challenge. This review article aims to provide an overview of anticoagulant use in AF patients with difficult scenarios.

COVID-19 associated atrial fibrillation: Incidence, putative mechanisms and potential clinical implications

“…Contemporary therapy of AF with antiarrhythmic drugs and anticoagulants is complex and suboptimal and is associated with substantial side effects. [74] , [75] Little data are available on the value of rhythm and rate control strategies in AF patients with COVID-19 patients. Intensified treatment of the underlying hypoxemia, inflammation and other reversible triggers (i.e.…”

On‐demand mobile health infrastructures to allow comprehensive remote atrial fibrillation and risk factor management through teleconsultation

“…Besides the management of AF (ie, heart rate and/or rhythm control strategy to improve symptoms) alone, it is crucial to determine the potential stroke risk and prescribe appropriate oral anticoagulation accordingly to prevent thromboembolic complications; management of precipitating factors (such as underlying cardiovascular conditions and modifiable risk factors) to reduce the cardiovascular burden to consequently reduce the AF burden. [33,[38][39][40] These four fundamentals form the basis of an integrated AF care approach and the use of mHealth solutions through teleconsultations, seamlessly fits within an AF-clinic as well as with the aims of integrated care: improving outcomes while preventing fragmentation of care. One possible pathway to implement an on-demand mHealth infrastructure for remote heart rate, rhythm and risk factor assessment to allow comprehensive AF management through teleconsultation is shown in Figure 4.…”

“…Besides the management of AF (ie, heart rate and/or rhythm control strategy to improve symptoms) alone, it is crucial to determine the potential stroke risk and prescribe appropriate oral anticoagulation accordingly to prevent thromboembolic complications; management of precipitating factors (such as underlying cardiovascular conditions and modifiable risk factors) to reduce the cardiovascular burden to consequently reduce the AF burden. [ 33,38‐40 ]…”

The gut microbial-derived metabolite trimethylamine N-oxide: A missing link between lifestyle-components and atrial fibrillation?

“…Despite continuous improvement in our knowledge about atrial fibrillation (AF) pathophysiology, pharmacological, ablative and surgical treatments are still suboptimal, so AF remains a challenge of contemporary cardiology [1] , [2] , [3] , [4] . Although there are many well-established predisposing conditions and risk factors for AF, there is still a clear unmet need to expand knowledge of new mechanisms and treatment strategies to reduce morbidity and mortality in AF patients.…”