TY - JOUR
T1 - Stroke prevention in atrial fibrillation
T2 - Evidence from real-life studies
AU - Akao, Masaharu
AU - Beyer-Westendorf, Jan
AU - Goto, Shinya
AU - Peterson, Eric
N1 - Publisher Copyright:
© The Author 2015.
PY - 2015
Y1 - 2015
N2 - Atrial fibrillation (AF) is an increasing public health issue, especially owing to a accompanying five-fold increased risk of stroke. Anticoagulants are the cornerstone o therapy for stroke prevention in AF. The clinical benefits of Vitamin K antagonists (VKAs namely warfarin) shown in randomized controlled trials (RCTs) have been challenge when used in clinical practice by issues including the need for international normalize ratio (INR) monitoring, food and drug interactions, low time in the therapeutic range i substantial numbers of patients, and serious bleeding events. Combined, these have le to both an under-initiation of VKAs and high rates of VKA discontinuation. Non-VKA ora anticoagulants (NOACs), including the oral, direct factor Xa inhibitors apixaban an rivaroxaban and the oral, direct thrombin inhibitor dabigatran, are transforming th anticoagulation landscape. These agents have shown favourable outcomes in Phase II RCTs and are licensed for the use in Europe and many other regions around the world fo stroke prevention in AF. However, the safety and effectiveness of NOACs in real-worl patients with AF outside RCTs is not well understood. Non-interventional studies an registries are becoming ever more important in understanding the real-life benefit-ris profile of NOACs. This review will evaluate questions that remain unanswered despite th wealth of RCT data available, and will describe a number of pivotal real-life studies tha have been completed or are ongoing in the area of stroke prevention in AF, in an effort t extendour understandingofNOACuse toroutineclinicalpracticeandoptimisepatientcare.
AB - Atrial fibrillation (AF) is an increasing public health issue, especially owing to a accompanying five-fold increased risk of stroke. Anticoagulants are the cornerstone o therapy for stroke prevention in AF. The clinical benefits of Vitamin K antagonists (VKAs namely warfarin) shown in randomized controlled trials (RCTs) have been challenge when used in clinical practice by issues including the need for international normalize ratio (INR) monitoring, food and drug interactions, low time in the therapeutic range i substantial numbers of patients, and serious bleeding events. Combined, these have le to both an under-initiation of VKAs and high rates of VKA discontinuation. Non-VKA ora anticoagulants (NOACs), including the oral, direct factor Xa inhibitors apixaban an rivaroxaban and the oral, direct thrombin inhibitor dabigatran, are transforming th anticoagulation landscape. These agents have shown favourable outcomes in Phase II RCTs and are licensed for the use in Europe and many other regions around the world fo stroke prevention in AF. However, the safety and effectiveness of NOACs in real-worl patients with AF outside RCTs is not well understood. Non-interventional studies an registries are becoming ever more important in understanding the real-life benefit-ris profile of NOACs. This review will evaluate questions that remain unanswered despite th wealth of RCT data available, and will describe a number of pivotal real-life studies tha have been completed or are ongoing in the area of stroke prevention in AF, in an effort t extendour understandingofNOACuse toroutineclinicalpracticeandoptimisepatientcare.
KW - Atrial fibrillation
KW - Direct factor Xa inhibitors
KW - Direct thrombin inhibitors
KW - Real-world clinical trials
KW - Stroke
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U2 - 10.1093/eurheartj/suv037
DO - 10.1093/eurheartj/suv037
M3 - Article
AN - SCOPUS:84968688401
SN - 1520-765X
VL - 17
SP - D42-D52
JO - European Heart Journal, Supplement
JF - European Heart Journal, Supplement
ER -