Antithrombotic and anticoagulant therapy for atrial fibrillation

Abstract

Atrial fibrillation (AF) substantially increases the risk of stroke and other thromboembolic events. Hence, the vast majority of AF patients require appropriate antithrombotic prophylaxis. Oral anticoagulation (OAC) with either dose-adjusted vitamin K antagonist (VKA, e.g. warfarin) or non-VKA oral anticoagulants (NOACs, e.g. dabigatran, apixaban, rivaroxaban) can be used for this purpose unless contraindicated. Therefore, stroke and bleeding risk assessment is an obligatory part of AF management and risk has to be weighed individually. Antiplatelet drugs (e.g. aspirin and clopidogrel) are inferior to OACs, both alone and in combination, with comparable risk of bleeding events. Exclusion of the left atrial appendage as major source of embolism in AF is an alternative option for stroke prevention in the few high risk patients with contraindications for anticoagulation.