Stroke prevention in atrial fibrillation: Evidence from real-life studies

Masaharu Akao, Jan Beyer-Westendorf, Shinya Goto, Eric Peterson

Research output: Contribution to journalArticlepeer-review

Abstract

Atrial fibrillation (AF) is an increasing public health issue, especially owing to a accompanying five-fold increased risk of stroke. Anticoagulants are the cornerstone o therapy for stroke prevention in AF. The clinical benefits of Vitamin K antagonists (VKAs namely warfarin) shown in randomized controlled trials (RCTs) have been challenge when used in clinical practice by issues including the need for international normalize ratio (INR) monitoring, food and drug interactions, low time in the therapeutic range i substantial numbers of patients, and serious bleeding events. Combined, these have le to both an under-initiation of VKAs and high rates of VKA discontinuation. Non-VKA ora anticoagulants (NOACs), including the oral, direct factor Xa inhibitors apixaban an rivaroxaban and the oral, direct thrombin inhibitor dabigatran, are transforming th anticoagulation landscape. These agents have shown favourable outcomes in Phase II RCTs and are licensed for the use in Europe and many other regions around the world fo stroke prevention in AF. However, the safety and effectiveness of NOACs in real-worl patients with AF outside RCTs is not well understood. Non-interventional studies an registries are becoming ever more important in understanding the real-life benefit-ris profile of NOACs. This review will evaluate questions that remain unanswered despite th wealth of RCT data available, and will describe a number of pivotal real-life studies tha have been completed or are ongoing in the area of stroke prevention in AF, in an effort t extendour understandingofNOACuse toroutineclinicalpracticeandoptimisepatientcare.

Original languageEnglish (US)
Pages (from-to)D42-D52
JournalEuropean Heart Journal, Supplement
Volume17
DOIs
StatePublished - 2015
Externally publishedYes

Keywords

  • Atrial fibrillation
  • Direct factor Xa inhibitors
  • Direct thrombin inhibitors
  • Real-world clinical trials
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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