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Solutions to Reduce Cardiovascular Events in Patients with Atrial Fibrillation

Atrial fibrillation (AF) is a risk factor for stroke and is associated with increased mortality. Risk stratification for ischemic stroke in AF patients is based on scores which incorporate several risk factors as previous stroke or transient ischemic attack, age, hypertension, diabetes, and heart failure. Antithrombotic therapy is tailored according to the level of risk, with vitamin K antagonists (VKA) reserved to medium-high risk patients. There is good evidence for the benefit of VKA in preventing stroke and reducing mortality. However, a large proportion of patients do not receive VKA, mainly due to concerns regarding bleeding complications, particularly in elderly patients. There are a number of risk factors for stroke that are not recognized by the risk scores currently in use,  as female gender, atherosclerotic vascular disease, valvular dysfunction and myocardial infarction. Consequently, the stroke risk in many patients could be underestimated, and these patients could receive a suboptimal antithrombotic prophylaxis. Several refinements of current risk scores are in development. Various oral anticoagulants (direct thrombin inhibitors and direct Factor Xa inhibitors) are available for stroke prevention in patients with AF overcoming some of the difficulties associated with VKAs. Advances in identifying patients at risk of stroke and drug development together may overcome the current difficulties in providing effective stroke prevention for all patients at risk.

Credits: Maurizio Paciaroni; Giancarlo Agnelli

Biosense Webster
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Introduction to AFib
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