Individualised approaches to thrombo-prophylaxis in atrial fibrillation

Publication date: Available online 11 November 2015 Source:American Heart Journal Author(s): Oliver J. Ziff, A. John Camm Atrial fibrillation (AF) is the most common arrhythmia worldwide. The prevalence of AF in adults over 55 years of age is at least 33.5 million globally and is predicted to more than double in the next half-century. Anticoagulation, heart-rate control, and heart-rhythm control comprise the three main treatment strategies in AF. Anticoagulation is aimed at preventing debilitating stroke, systemic embolism and associated mortality. Historically, anticoagulation in AF was achieved with a vitamin K antagonist (VKA) such as warfarin, which is supported by evidence demonstrating reduced incident stroke and all-cause mortality. However, warfarin has unpredictable pharmacokinetics with many drug-drug interactions that require regular monitoring to ensure patients remain in the therapeutic anticoagulant range. Non-VKA oral anticoagulants (NOACs) including dabigatran, rivaroxaban, apixaban, and edoxaban provide a possible solution to these issues with their more predictable pharmacokinetics, rapid onset of action and greater specificity. Results from large randomised, controlled trials indicate that these agents are at least non-inferior to warfarin in prevention of stroke. These trials also demonstrate a consistently lower incidence of intracranial haemorrhage (ICH), almost always all life-threatening bleeds and many forms of major bleeds with the possible e...
Source: American Heart Journal - Category: Cardiology Source Type: research