Stroke prevention in atrial fibrillation – latest guideline recommendations and real world data.

Abstract

Atrial fibrillation (AF) occurs with a prevalence of 1 % in the general population, up to 8 % in patients over 80 years of age and can lead to palpitations, tachycardia, hospitalization for heart failure and stroke. In order to prevent strokes, oral anticoagulation is necessary. In the 2016 guidelines for the management of atrial fibrillation, non vitamin K anticoagulants (NOACs) are preferred among vitamin K anticoagulants due to less severe bleeding, especially intracranial haemorrhage. There is also no longer evidence for antiplatelet therapy in AF. Apart from randomized controlled trials it has been shown in real world data that use of NOACs is safe and feasible. NOACs are not indicated in patients with mechanical valve replacement and valvular atrial fibrillation. Since November 2015 the first specific antidote for dabigatran is available in Germany, a factor Xa antidote (apixaban, rivaroxaban, edoxaban) is being tested in a phase III study.