Stroke Prevention with Anticoagulant in Cardiovascular Problem: Focus in Atrial Fibrillation

Abstract

Cardiovascular problems such as atrial fibrillation is a serious and growing health problem in the global community. The presence of atrial fibrillation increases the risk of stroke, which in turn has its own problems and impact. Data have shown that the use of warfarin reduces the risk of stroke in patients with atrial fibrillation, yet this drug has been historically underutilized due to challenges with its use.New oral anticoagulants (NOACs) are easier to use, have a lower risk of major bleeding, and have been shown to be non-inferior, and in some cases, superior to warfarin. NOACs have started to replace warfarin as the first choice anticoagulant in clinical practice. Optimal strategies to reduce stroke and risk of major bleeding in subsets of atrial fibrillation patients undergoing Percutaneous Coronary Intervention (PCI) and ablation will continue to evolve. When evaluating patients with AF, care should be taken to address the risk of stroke and provide recommendations on the use of anticoagulation to reduce it.As atrial fibrillation becomes the most prevalent arrhythmia that is associated with an increased risk of ischemic stroke, stroke prevention is crucial for management of atrial fibrillation patients. The NOACs, such as dabigatran, rivaroxaban, apixaban and edoxaban, are at least as effective as warfarin in reducing ischemic stroke with a lower rate of major bleeding. This review article provides evidence on the performance of NOACs in AF patients with different clinical conditions. Despite the evidence from recent trials, further research is necessary for patients undergoing PCI, bioprosthetic valve replacement, transcatheter aortic valve intervention, mitraclip and for those requiring long-term antiplatelet therapy over anticoagulation.