Oral anticoagulation to reduce risk of stroke in patients with atrial fibrillation: current and future therapies

Abstract

Atrial fibrillation (AF) is associated with an increased incidence and severity of strokes. The burden of AF-related stroke is expected to increase in parallel with the aging of the population. Oral anticoagulation with warfarin has been the pharmacologic standard for stroke risk reduction in patients with AF. When used with close attention to dosing and monitoring, warfarin is effective prophylactic therapy against thromboembolic stroke. However, it is underused by physicians, in part because of the known risks of adverse events with warfarin. Consequently, many patients with AF live with an avoidably elevated risk of stroke. New options, ie, oral anticoagulants with novel mechanisms of action, have recently been approved to reduce the risk of stroke in AF, and others are in development. These newer agents may address some of the complexities of warfarin use while providing similar or better efficacy and safety.

Keywords:

• atrial fibrillation
• stroke
• oral anticoagulants

Disclosure

The author acknowledges the writing and editorial assistance of UBC-Envision Group, the services of which were funded by Boehringer Ingelheim Pharmaceuticals Inc. The author meets criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE), was fully responsible for all content and editorial decisions, and was involved in all stages of manuscript development. The author received no compensation related to the development of the manuscript. Otherwise, the author reports no conflicts of interest in this work.