Atrial Fibrillation and Stroke. A Review on the Use of Vitamin K Antagonists and Novel Oral Anticoagulants
Abstract
:1. Introduction
- Heart rate control with either beta blockers (Bisoprolol, Metoprolol), non-dihydropyridine calcium antagonists (Verapamil, Diltiazem), digoxin (less used due to the possible risk of toxicity, especially in patients with renal insufficiency) or, as a last resort, Amiodarone;
- Either electrical or pharmacological cardioversion with class antiarrhythmics III (Amiodarone, Ibutilide) or I-C (Flecainide, propafenone, in the absence of cardiac structural damage);
- AF deletion through catheter ablation, either by acting on its trigger points or by altering the arrhythmogenic substrate. In either case, the risk of relapse still persists, especially during the first 6–12 months after the procedure;
- The control of thrombo-embolic complications by using anticoagulants (novel oral anticoagulants (NOACs), vitamin K antagonists (VKAs), heparin).
2. Atrial Fibrillation (FA) Cardioversion and Anticoagulation
3. Oral Anticoagulation with Vitamin K Antagonists
4. Novel Oral Anticoagulants (NOACs): A Future Already Present
5. Bridging Therapy
6. Anticoagulant Therapy: An Upcoming Challenge
7. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Risk Factors | Score | CHA2DS2-VASc Score | Stroke Risk Per Year |
---|---|---|---|
Congestive Heart Failure | 1 | 0 | 0% |
LV Dysfunction | 1 | 1 | 1.3% |
Hypertension | 1 | 2 | 2.2% |
Age ≥ 75 years | 2 | 3 | 3.2% |
Diabetes Mellitus | 1 | 4 | 4.0% |
Stroke/TIA/Thromboembolism | 2 | 5 | 6.7% |
Vascular Disease | 1 | 6 | 9.8% |
Age 65–74 | 1 | 7 | 9.6% |
Female | 1 | 8 | 6.7% |
Total | 9 | 9 | 15.2% |
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Caturano, A.; Galiero, R.; Pafundi, P.C. Atrial Fibrillation and Stroke. A Review on the Use of Vitamin K Antagonists and Novel Oral Anticoagulants. Medicina 2019, 55, 617. https://doi.org/10.3390/medicina55100617
Caturano A, Galiero R, Pafundi PC. Atrial Fibrillation and Stroke. A Review on the Use of Vitamin K Antagonists and Novel Oral Anticoagulants. Medicina. 2019; 55(10):617. https://doi.org/10.3390/medicina55100617
Chicago/Turabian StyleCaturano, Alfredo, Raffaele Galiero, and Pia Clara Pafundi. 2019. "Atrial Fibrillation and Stroke. A Review on the Use of Vitamin K Antagonists and Novel Oral Anticoagulants" Medicina 55, no. 10: 617. https://doi.org/10.3390/medicina55100617