Atrial fibrillation (AF) management has been transformed within the last decade by revised clinical guidance and availability of new drugs. Aspirin monotherapy, once accounting for almost half of all antithrombotic prescriptions for AF, is now an obsolete therapy. Anticoagulation is the treatment of choice for AF and direct oral anticoagulants (DOACs) have overtaken warfarin as the drug of first choice for new starters. However, management of one in four people with AF remains suboptimal, and this article reviews the major issues around antithrombotic and other treatments for AF.
This month’s Back to Basics summarizes the main features of the key direct oral anticoagulants (DOACs or NOACS). These drugs are becoming a standard therapy in many settings including stroke prevention, management of deep vein thrombosis and pulmonary embolism, and prevention of venous thromboembolism following hip and knee replacement.
Atrial fibrillation (AF) is the commonest sustained cardiac dysrhythmia, but is asymptomatic in about one quarter of patients. Case finding with subsequent assessment of the risk of stroke and bleeding are essential to ensure that the right patients receive appropriate intervention with oral anticoagulation.
The prevalence of atrial fibrillation (AF), together with the condition’s associated stroke and systemic thromboembolic risk, is increasing significantly. Fortunately, there are clear, evidence-based clinical guidelines and risk stratification tools, to ensure that patients can make informed choices about optimising their treatment and care.
Stroke related to atrial fibrillation can be prevented effectively through the use of anticoagulants. This article reviews recent guidelines, clinical trials and real-world evidence with non-vitamin K antagonist oral anticoagulants (NOACs) in patients with AF and provides practical guidance on the use of these newer agents in primary care.
Recent guidelines recommend two key steps to reduce ischaemic stroke in people with atrial fibrillation: 1. Improving the assessment of stroke risk and 2. Increasing the use of evidence-based anticoagulant therapy. In this article, leading specialists explain how to apply current guidelines to improve current practice in stroke prevention.
Are they all the same? What are the risks?
Dr Frances Akinwunmi
Consultant Pharmacist (Anticoagulation), Imperial College Healthcare NHS Trust
Professor David Fitzmaurice
Professor of Primary Care, University of Birmingham
Dr Matthew Fay
GP and National Clinical Lead for Atrial Fibrillation, Westcliffe Medical Centre, Shipley
Dr Patrick Kesteven
Consultant Haematologist, Freeman Hospital, Newcastle-upon-Tyne
What are the issues which need to be considered? What are the priorities? Are there pitfalls?
Head of Service Improvement and Quality, Dudley Clinical Commissioning Group
Atrial fibrillation (AF) is the commonest arrhythmia in the community. The lifetime risk of developing AF is one in six, rising steeply with age over 50 years. People with AF have six times the risk of having a stroke and twice the risk of death compared to those with sinus rhythm.
We live in exciting times with the development of several new oral anticoagulant agents, including the recent approval of the direct thrombin inhibitor dabigatran for the prevention of stroke and systemic embolism in patients with atrial fibrillation (AF). Dabigatran, an oral agent with fixed dosing, is an attractive alternative to warfarin which has recently been made available in the UK. What are the implications for UK primary care? Many patients with AF receive substandard anticoagulation and are therefore at risk of stroke. Evidence for its efficacy and its potential place in clinical practice is reviewed.