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Overcoming global challenges in stroke prophylaxis in atrial fibrillation : The role of non-vitamin K antagonist oral anticoagulants

Massaro, Ayrton; Giugliano, Robert P.; Norrving, Bo LU ; Oto, Ali and Veltkamp, Roland (2016) In International Journal of Stroke 11(9). p.950-967
Abstract

Atrial fibrillation is the world's most common sustained cardiac arrhythmia and is associated with a significantly increased risk of stroke. The global burden of atrial fibrillation is rising, commensurate with the ageing population. Well-controlled vitamin K antagonist-based anticoagulation has been shown to reduce the risk of stroke secondary to atrial fibrillation by two-thirds. However, patients with atrial fibrillation have frequently been denied anticoagulation because of a variety of perceived risks related to bleeding, falls, chronological age, and poor compliance. Even when vitamin K antagonists are used, maximum benefit and safety are only delivered when high quality control of therapy (TTR > 70%) is achieved, which has... (More)

Atrial fibrillation is the world's most common sustained cardiac arrhythmia and is associated with a significantly increased risk of stroke. The global burden of atrial fibrillation is rising, commensurate with the ageing population. Well-controlled vitamin K antagonist-based anticoagulation has been shown to reduce the risk of stroke secondary to atrial fibrillation by two-thirds. However, patients with atrial fibrillation have frequently been denied anticoagulation because of a variety of perceived risks related to bleeding, falls, chronological age, and poor compliance. Even when vitamin K antagonists are used, maximum benefit and safety are only delivered when high quality control of therapy (TTR > 70%) is achieved, which has proven remarkably difficult in many health-care systems and amongst many patient groups. The non-vitamin K antagonist oral anticoagulants (NOACs) offer solutions to many of the challenges of achieving widespread, safe, and effective anticoagulation for stroke prophylaxis in atrial fibrillation, yet their uptake into routine clinical practice remains variable. The evidence supporting their more widespread use to overcome the challenges of stroke prophylaxis for atrial fibrillation is reviewed in this article.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
anticoagulation, atrial fibrillation, non-VKA oral anticoagulants, Stroke
in
International Journal of Stroke
volume
11
issue
9
pages
18 pages
publisher
Wiley-Blackwell
external identifiers
  • scopus:84995872868
  • wos:000389205800004
ISSN
1747-4930
DOI
10.1177/1747493016660106
language
English
LU publication?
yes
id
2acb1fe1-5cdb-4c3d-bf57-a2622848ea6b
date added to LUP
2016-12-02 13:38:08
date last changed
2017-09-18 11:32:09
@article{2acb1fe1-5cdb-4c3d-bf57-a2622848ea6b,
  abstract     = {<p>Atrial fibrillation is the world's most common sustained cardiac arrhythmia and is associated with a significantly increased risk of stroke. The global burden of atrial fibrillation is rising, commensurate with the ageing population. Well-controlled vitamin K antagonist-based anticoagulation has been shown to reduce the risk of stroke secondary to atrial fibrillation by two-thirds. However, patients with atrial fibrillation have frequently been denied anticoagulation because of a variety of perceived risks related to bleeding, falls, chronological age, and poor compliance. Even when vitamin K antagonists are used, maximum benefit and safety are only delivered when high quality control of therapy (TTR &gt; 70%) is achieved, which has proven remarkably difficult in many health-care systems and amongst many patient groups. The non-vitamin K antagonist oral anticoagulants (NOACs) offer solutions to many of the challenges of achieving widespread, safe, and effective anticoagulation for stroke prophylaxis in atrial fibrillation, yet their uptake into routine clinical practice remains variable. The evidence supporting their more widespread use to overcome the challenges of stroke prophylaxis for atrial fibrillation is reviewed in this article.</p>},
  author       = {Massaro, Ayrton and Giugliano, Robert P. and Norrving, Bo and Oto, Ali and Veltkamp, Roland},
  issn         = {1747-4930},
  keyword      = {anticoagulation,atrial fibrillation,non-VKA oral anticoagulants,Stroke},
  language     = {eng},
  month        = {12},
  number       = {9},
  pages        = {950--967},
  publisher    = {Wiley-Blackwell},
  series       = {International Journal of Stroke},
  title        = {Overcoming global challenges in stroke prophylaxis in atrial fibrillation : The role of non-vitamin K antagonist oral anticoagulants},
  url          = {http://dx.doi.org/10.1177/1747493016660106},
  volume       = {11},
  year         = {2016},
}