Stroke prevention in atrial fibrillation: comparison of recent international guidelines

Author:

Chao Tze-Fan12,Nedeljkovic Milan A34,Lip Gregory Y H56,Potpara Tatjana S34

Affiliation:

1. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

2. Institute of Clinical Medicine, Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan

3. School of Medicine, University of Belgrade, dr Subotica 8, 11000 Belgrade, Serbia

4. Cardiology Clinic, Clinical Centre of Serbia, Visegradska 26, 11000 Belgrade, Serbia

5. Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool Heart & Chest Hospital, Liverpool, UK

6. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

Abstract

Abstract Stroke prevention is one of the cornerstones of management in patients with atrial fibrillation (AF). As part of the ABC (Atrial fibrillation Better Care) pathway (A: Avoid stroke/Anticoagulation; B: Better symptom control; C: Cardiovascular risk and comorbidity optimisation), stroke risk assessment and appropriate thromboprophylaxis is emphasised. Various guidelines have addressed stroke prevention. In this review, we compared the 2017 APHRS, 2018 ACCP, 2019 ACC/AHA/HRS, and 2020 ESC AF guidelines regarding the stroke/bleeding risk assessment and recommendations about the use of OAC. We also aimed to highlight some unique points for each of those guidelines. All four guidelines recommend the use of the CHA2DS2-VASc score for stroke risk assessment, and OAC (preferably NOACs in all NOAC-eligible patients) is recommended for AF patients with a CHA2DS2-VASc score ≥2 (males) or ≥3 (females). Guidelines also emphasize the importance of stroke risk reassessments at periodic intervals (e.g. 4–6 months) to inform treatment decisions (e.g. initiation of OAC in patients no longer at low risk of stroke) and address potentially modifiable bleeding risk factors.

Funder

Boehringer Ingelheim

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine

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