Anticoagulants & Preventing Stroke in Atrial Fibrillation

Depending on a patient’s comorbidities and history of prior cerebrovascular events, the rate of stroke among adults with atrial fibrillation (AF) varies widely, ranging between 1% and 20% annually. It is important to stratify the risk of stroke to determine whether prophylactic treatment with an anticoagulant is warranted because the medications used to lower the incidence of AF-related stroke are associated with bleeding. “Aspirin and warfarin have been the primary medications used to prevent stroke in patients with nonvalvular AF (NVAF),” says Larry B. Goldstein, MD, FAAN, FAHA. “Aspirin is indicated primarily for lower-risk patients, while warfarin is reserved for those at greater thromboembolic risk.” Until recently, the American Heart Association and the American Stroke Association (AHA/ASA) have centered their recommendations on preventing stroke in patients with NVAF around using aspirin or warfarin. There are also some data reflecting the use of clopidogrel plus aspirin as compared to warfarin or aspirin alone. The Role of Newer Antithrombotic Agents The new antithrombotics are alternatives to warfarin and aspirin for patients with NVAF. In the August 2, 2012 online issue of Stroke, the AHA/ ASA released a science advisory for healthcare professionals reviewing these new oral antithrombotic agents and providing revised management recommendations. The AHA/ASA scientific advisory updates its existing guidelines based on clinical trial data for three new antithrombotic drugs that have been evaluated in patients with NVAF. “When selecting specific agent for stroke prevention in AF, clinicians must individualize treatment decisions based on risk factors, cost, and tolerability.” —Larry B. Goldstein, MD, FAAN, FAHA “We reviewed recent trials that tested the safety and efficacy of dabigatran—a direct thrombin inhibitor—and...