Via practica 2/2017

Anticoagulant therapy in patients with atrial fibrillation

Atrial fibrillation (AF) is a common arrhythmia, which incidence is increasing exponentially. AF is associated with reduced quality of life, increased mortality, especially cardiovascular and 20 – 30 % of all strokes are due to AF. We recommend estimating stroke risk in AF patients based on the CHA2DS2-VASc score. Several bleeding risk scores have been developed to identify modifiable and non-modifiable risk factors for bleeding. Non-vitamin K antagonist oral anticoagulants (NOACs) (the direct thrombin inhibitor dabigatran and the factor Xa inhibitors apixaban, edoxaban, and rivaroxaban) are suitable alternatives to vitamin K antagonists for stroke prevention in AF. Their use in clinical practice is increasing rapidly. Oral anticoagulation therapy to prevent thromboembolism is recommended for all male AF patients with a CHA2DS2-VASc score of 2 or more and all female AF patients with a CHA2DS2-VASc score of 3 or more. Antiplatelet monotherapy is not recommended for stroke prevention in AF patients, regardless of stroke risk. Combinations of oral anticoagulants and platelet inhibitors increase bleeding risk and should be avoided in AF patients without another indication for platelet inhibition. NOACs are recommended in preference to VKAs or aspirin in AF patients with a previous stroke.

Keywords: atrial fibrillation, vitamin K antagonists, new oral anticoagulation, risk score