Evolving strategies to prevent stroke and thromboembolism in nonvalvular atrial fibrillation

Abstract

Stroke prevention in patients with nonvalvular atrial fibrillation relies on an assessment of the individualrisks for stroke and bleeding. Patients at highrisk for stroke are candidates for anticoagulanttherapy. Anticoagulants, however, have substantialbleeding risks that must be weighed in thetherapeutic decision. Warfarin has been thetraditional choice, but the recently introducednovel oral anticoagulants offer similar efficacy withless bleeding risk. Additionally, they do not requiremonitoring and have fewer drug interactions anddietary restrictions than warfarin. Several devices,which isolate the left atrial appendage, havebecome available as treatment options for patientswith elevated risks of both thromboembolism andbleeding complications