Prevention of cardioembolic stroke in patients with atrial fibrillation

Abstract

Atrial fibrillation (AF) is the most common cardiac arrhythmia and an important independent stroke risk factor, especially in the elderly. This article provides the reader with an overview as well as an update on primary and secondary stroke prevention strategies in patients with AF. Vitamin K antagonists remain the cornerstone therapy in AF patients at high risk of stroke. Both aspirin monotherapy and the combination of aspirin and clopidogrel are inferior to vitamin K antagonists in patients with AF. The new direct thrombin inhibitor dabigatran is at least as effective as warfarin and leads to a significant and clinically relevant decrease in hemorrhagic stroke and intracranial bleeds. Interventional therapies such as percutaneous closure of the left atrial appendage or radiofrequency catheter ablation have not yet been proven to decrease the stroke risk in patients with AF.

Keywords::

• antiarrhythmics
• antiplatelets
• atrial fibrillation
• factor Xa inhibitors
• interventional therapy
• prevention
• stroke
• thrombin inhibitors
• warfarin

Financial & competing interests disclosure

Hans-Christoph Diener received honoraria for participation in clinical trials, contribution to advisory boards or oral presentations from: Abbott, AstraZeneca, Bayer Vital, BMS, Boehringer Ingelheim, CoAxia, D-Pharm, Fresenius, GlaxoSmithKline, Janssen Cilag, Knoll, Medtronic, MindFrame, MSD, Neurobiological Technologies, Novartis, Novo-Nordisk, Paion, Parke-Davis, Pfizer, Sankyo, Sanofi-Aventis, Schering-Plough, Servier, Solvay, Thrombogenics, Wyeth and Yamaguchi. Financial support for research projects was provided by AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, Lundbeck, Novartis, Janssen-Cilag, Sanofi-Aventis, Syngis and Talecris. Hans-Christoph Diener has no ownership interest and does not own stocks of any pharmaceutical company. Christian Weimar received honoraria for participation in clinical trials, contribution to advisory boards or oral presentations from: Boehringer Ingelheim, Bristol-Myers Squib, CoAxia. Daiichi Asubio, D-Pharm, GlaxoSmithKline, Lundbeck, Medtronic, MindFrame, Neurobiological Technologies, Novartis, Novo-Nordisk and Sanofi-Aventis. Christian Weimar has no ownership interest and does not own stocks of any pharmaceutical company exceeding €10,000. The Department of Neurology at the University Duisburg-Essen received research grants from the German Research Council (DFG), German Ministry of Education and Research (BMBF), EU, NIH, Bertelsmann Foundation and Heinz-Nixdorf Foundation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.