The gray areas of oral anticoagulation for prevention of thromboembolic events in atrial fibrillation patients

Author:

Curcio Antonio1,Anselmino Matteo2,Di Biase Luigi3,Migliore Federico4,Nigro Gerardo5,Rapacciuolo Antonio6,Sergi Domenico7,Tomasi Luca8,Pedrinelli Roberto9,Mercuro Giuseppe10,Filardi Pasquale Perrone6,Indolfi Ciro111

Affiliation:

1. Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University

2. Division of Cardiology, ‘Città della Salute e della Scienza di Torino’ Hospital, Department of Medical Sciences, University of Turin, Italy

3. Albert Einstein College of Medicine at Montefiore Hospital, New York, New York, USA

4. Department of Cardiac, Thoracic Vascular Sciences and Public Health University of Padova, Padova

5. Università della Campania Luigi Vanvitelli (Second University of Naples)

6. Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples

7. Unit of Cardiology, Department of Systems Medicine, University of Rome Tor Vergata, Rome

8. Department of Cardiac, Thoracic and Vascular Sciences, University of Verona, Verona

9. Department of Surgical, Clinical and Molecular Pathology and Intensive Care, University of Pisa, Pisa

10. Department of Internal Sciences and Public Health, University of Cagliari, Cagliari

11. Mediterranea Cardiocentro, Naples, Italy

Abstract

Thromboembolic events (TEE) associated with atrial fibrillation (AF) are highly recurrent and usually severe, causing permanent disability or, even, death. Previous data consistently showed significantly lower TEE in anticoagulated patients. While warfarin, a vitamin K antagonist, is still used worldwide, direct-acting oral anticoagulants (DOACs) have shown noninferiority to warfarin in the prevention of TEE, and represent, to date, the preferred treatment. DOACs present favorable pharmacokinetic, safety and efficacy profiles, especially among vulnerable patients including the elderly, those with renal dysfunction or previous TEE. Yet, regarding specific settings of AF patients it is unclear whether oral anticoagulation therapy is beneficial, or otherwise it is the maintenance of sinus rhythm, mostly achieved through a catheter ablation-based rhythm control strategy, that prevents the causal complications linked to AF. While it is known that low-risk patients [CHA2DS2-VASc 0 (males), or score of 1 (females)] present low ischemic stroke or mortality rates (<1%/year), it remains unclear whether they need any prophylaxis. Furthermore, the appropriate anticoagulation regimen for those individuals requiring cardioversion, either pharmacologic or electric, as well as peri-procedural anticoagulation in patients undergoing trans-catheter ablation that nowadays encompasses different energies, are still a matter of debate. In addition, AF concomitant with other clinical conditions is discussed and, lastly, the choice of prescribing anticoagulation to asymptomatic patients diagnosed with subclinical AF at either wearable or implanted devices. The aim of this review will be to provide an update on current strategies in the above-mentioned settings, and to suggest possible therapeutic options, finally focusing on AF-related cognitive decline.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine,General Medicine

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3