Anticoagulation in atrial fibrillation.

Published online

Journal Article (Review)

Atrial fibrillation increases the risk of stroke, which is a leading cause of death and disability worldwide. The use of oral anticoagulation in patients with atrial fibrillation at moderate or high risk of stroke, estimated by established criteria, improves outcomes. However, to ensure that the benefits exceed the risks of bleeding, appropriate patient selection is essential. Vitamin K antagonism has been the mainstay of treatment; however, newer drugs with novel mechanisms are also available. These novel oral anticoagulants (direct thrombin inhibitors and factor Xa inhibitors) obviate many of warfarin's shortcomings, and they have demonstrated safety and efficacy in large randomized trials of patients with non-valvular atrial fibrillation. However, the management of patients taking warfarin or novel agents remains a clinical challenge. There are several important considerations when selecting anticoagulant therapy for patients with atrial fibrillation. This review will discuss the rationale for anticoagulation in patients with atrial fibrillation; risk stratification for treatment; available agents; the appropriate implementation of these agents; and additional, specific clinical considerations for treatment.

Full Text

Duke Authors

Cited Authors

  • Steinberg, BA; Piccini, JP

Published Date

  • April 14, 2014

Published In

Volume / Issue

  • 348 /

Start / End Page

  • g2116 -

PubMed ID

  • 24733535

Pubmed Central ID

  • 24733535

Electronic International Standard Serial Number (EISSN)

  • 1756-1833

Digital Object Identifier (DOI)

  • 10.1136/bmj.g2116

Language

  • eng

Conference Location

  • England