Recent advances in management of anti-coagulation in Atrial Fibrillation
Role of anti-coagulation in prevention of stroke in Atrial Fibrillation
Atrial fibrillation (AF) is the most common cardiac arrhythmia. It is more prevalent in men with increasing age. ( 11343485). Hypertensive heart disease and coronary heart disease are most common underlying disorders in patients with AF in developed countries. AF is classified based on 2014 AHA/ACC/HRS guidelines into Paroxysmal AF (AF that terminates spontaneously in less than 7 days), persistent AF (AF that fails to terminate in 7 days), long standing persistent AF (AF more than 12 months) and permanent AF (AF that is considered not amenable to rhythm control strategy). This classification…show more content… (20569748).
For non-valvular AF with CHAD2S2-Vasc score 2 or more than 2, benefits of oral anti-coagulation therapy (OAC) exceeds risk as shown in several studies. (22514252, 19721017, 21789337, 22186961). Scores of 1 entails various approaches for anti-coagulation depending on several factors including but not limited to patient’s age, safety, bleeding risks etc. For patients with score of 0, the risk of anti-coagulation outweighs the benefits, so no anti-coagulation is needed. Based on these findings, OAC is class 1 indication for patients with CHA2DS2-VASc score of 2 or more. (23558044, 22922413).
Benefits of New non-vitamin K oral anti-coagulants
Traditionally, warfarin has been the drug of choice for long term anti-coagulation in AF after initial bridging with heparin. Recently, newer non-vitamin K oral anti-coagulants (NOACs) are available for long term anti-coagulation in AF. These drugs inactivate both circulating and clot bound activated coagulation factors.(see figure 1 for mechanism of action). The two major class of NOAC available are direct thrombin inhibitor (DTI) and factor Xa inhibitor. Parenteral direct thrombin inhibitors include bivalirudin, argatroban and lepirudin. Oral direct thrombin inhibitors include dabigatran. Oral factor Xa inhibitors