Selection of Non-vitamin K Antagonist Oral Anticoagulant for Stroke Prevention in Atrial Fibrillation Based on Patient Profile: Perspectives from Vietnamese Experts. Part 1

Abstract

In Asia, especially Vietnam, AF is a common arrhythmia and is linked to a higher risk of stroke and systemic embolism. Anticoagulation therapy for stroke prevention in AF patients can result in bleeding complications. To effectively manage AF, adopting appropriate anticoagulation and addressing modifiable risk factors are crucial. Vietnamese clinicians are particularly interested in non-vitamin K antagonist oral anticoagulants (NOACs), a recent development in AF treatment. However, the lack of head-to-head trials comparing NOACs makes selecting a specific NOAC challenging. This review aims to provide a comprehensive overview of the available clinical evidence on NOACs for stroke prevention in AF to assist clinicians in making informed decisions and improving treatment outcomes in patients with AF. The first part of this review will present the current landscape of AF in Vietnam, focusing on AF prevalence and highlighting gaps in clinical practice. Furthermore, this part extensively discusses the anticoagulation strategy for both primary and secondary stroke prevention in AF.

Evaluating Renal Benefits of Rivaroxaban Versus Vitamin K Antagonists in Atrial Fibrillation: A Systematic Review and Meta-analysis of Real-world Evidence

“…1 In addition to the well-established risk of stroke, there has been increasing recognition of systemic comorbidities and complications associated with AF, including deterioration of renal function, which have garnered attention and have been addressed in clinical guidelines. [2][3][4] AF is associated with an elevated risk of impaired renal function, which can occur through several mechanisms, including decreased renal blood flow due to activation of the renin-angiotensin-aldosterone system and the formation of microthrombi, leading to renal microinfarction. [5][6][7] Furthermore, there is concern over the prolonged usage of oral anticoagulants in patients with AF, particularly vitamin K antagonists (VKAs), which accelerate the progression of renal disease.…”