Anticoagulation control in different ethnic groups receiving vitamin K antagonist therapy for stroke prevention in atrial fibrillation

Ischemic strokes related to atrial fibrillation are highly prevalent, presenting with severe neurologic syndromes and associated with high risk of recurrence. Although advances have been made in both primary and secondary stroke prevention for patients with atrial fibrillation, the long-term risks for stroke recurrence and bleeding complications from antithrombotic treatment remain substantial. We summarize the major advances in stroke prevention for patients with atrial fibrillation during the past 30 years and focus on novel diagnostic and treatment approaches currently under investigation in ongoing clinical trials. Non–vitamin K antagonist oral anticoagulants have been proven to be safer and equally effective compared with warfarin in stroke prevention for patients with nonvalvular atrial fibrillation. Non–vitamin K antagonist oral anticoagulants are being investigated for the treatment of patients with atrial fibrillation and rheumatic heart disease, for the treatment of patients with recent embolic stroke of undetermined source and indirect evidence of cardiac embolism, and in the prevention of vascular-mediated cognitive decline in patients with atrial fibrillation. Multiple clinical trials are assessing the optimal timing of non–vitamin K antagonist oral anticoagulant initiation after a recent ischemic stroke and the benefit:harm ratio of non–vitamin K antagonist oral anticoagulant treatment in patients with atrial fibrillation and history of previous intracranial bleeding. Ongoing trials are addressing the usefulness of left atrial appendage occlusion in both primary and secondary stroke prevention for patients with atrial fibrillation, including those with high risk of bleeding. The additive value of prolonged cardiac monitoring for subclinical atrial fibrillation detection through smartphone applications or implantable cardiac devices, together with the optimal medical management of individuals with covert paroxysmal atrial fibrillation, is a topic of intensive research interest. Colchicine treatment and factor XIa inhibition constitute 2 novel pharmacologic approaches that might provide future treatment options in the secondary prevention of cardioembolic stroke attributable to atrial fibrillation.

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Clopidogrel Added to Aspirin Reduces Stroke Risk in Atrial Fibrillation Patients Unsuitable for Vitamin K Antagonist Therapy

MD Conference Express ◽

10.1177/155989770902013 ◽

2009 ◽

Vol 9 (2) ◽

pp. 23-24

Author(s):

A. Jacobson ◽

S. J. Connolly

Keyword(s):

Atrial Fibrillation ◽

Vitamin K ◽

Stroke Risk ◽

Vitamin K Antagonist ◽

Antagonist Therapy

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Gaps in translation from trials to practice: Non-vitamin K antagonist oral anticoagulants (NOACs) for stroke prevention in atrial fibrillation

Thrombosis and Haemostasis ◽

10.1160/th13-12-1032 ◽

2014 ◽

Vol 111 (05) ◽

pp. 783-788 ◽

Cited By ~ 36

Author(s):

Darae Ko ◽

Christina L. Cove ◽

Elaine M. Hylek

Keyword(s):

Atrial Fibrillation ◽

Clinical Practice ◽

Vitamin K ◽

Stroke Prevention ◽

Current Knowledge ◽

Oral Anticoagulants ◽

Vitamin K Antagonist ◽

Major Advance ◽

Single Target ◽

Anticoagulant Drugs

SummaryWorldwide there is a tremendous need for affordable anticoagulants that do not require monitoring. The advent of the non-warfarin oral anticoagulant drugs represents a major advance for stroke prevention in atrial fibrillation (AF). The objectives of this review are to 1) identify gaps in our current knowledge regarding use of these single target anticoagulant drugs; 2) outline the potential implications of these gaps for clinical practice, and thereby, 3) highlight areas of research to further optimise their use for stroke prevention in AF.

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Factors associated with non–vitamin K antagonist oral anticoagulants for stroke prevention in patients with new-onset atrial fibrillation: Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II (ORBIT-AF II)

American Heart Journal ◽

10.1016/j.ahj.2017.03.024 ◽

2017 ◽

Vol 189 ◽

pp. 40-47 ◽

Cited By ~ 28

Author(s):

Benjamin A. Steinberg ◽

Peter Shrader ◽

Laine Thomas ◽

Jack Ansell ◽

Gregg C. Fonarow ◽

...

Keyword(s):

Atrial Fibrillation ◽

Vitamin K ◽

Stroke Prevention ◽

Oral Anticoagulants ◽

Vitamin K Antagonist ◽

Factors Associated ◽

Informed Treatment ◽

Onset Atrial Fibrillation ◽

New Onset

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Anticoagulation Control in Different Ethnic Groups Receiving Vitamin K Antagonist for Stroke Prevention in Atrial Fibrillation

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.736143 ◽

2021 ◽

Vol 8 ◽

Author(s):

Nur Azyyati Zawawi ◽

Izzati Abdul Halim Zaki ◽

Long Chiau Ming ◽

Hui Poh Goh ◽

Hanis Hanum Zulkifly

Keyword(s):

Atrial Fibrillation ◽

Clinical Outcome ◽

Ethnic Groups ◽

Therapeutic Range ◽

Stroke Prevention ◽

Warfarin Therapy ◽

Adverse Clinical Outcome ◽

Time In Therapeutic Range ◽

Anticoagulation Control

Vitamin K antagonist such as warfarin reduces the risk of stroke in atrial fibrillation (AF) patients. Since warfarin has a narrow therapeutic index, its administration needs to be regularly monitored to avoid any adverse clinical outcomes such as stroke and bleeding. The quality of anticoagulation control with warfarin therapy can be measured by using time in therapeutic range (TTR). This review focuses on the prevalence of AF, quality of anticoagulation control (TTR) and adverse clinical outcome in AF patients within different ethnic groups receiving warfarin therapy for stroke prevention. A literature search was conducted in Embase and PubMed using keywords of “prevalence,” “atrial fibrillation,” “stroke prevention,” “oral anticoagulants,” “warfarin,” “ethnicities,” “race” “time in therapeutic range,” “adverse clinical outcome,” “stroke, bleeding.” Articles published by 1st February 2020 were included. Forty-one studies were included in the final review consisting of AF prevalence (n = 14 studies), time in therapeutic range (n = 18 studies), adverse clinical outcome (n = 9 studies) within different ethnic groups. Findings indicate that higher prevalence of AF but better anticoagulation control among the Whites as compared to other ethnicities. Of note, non-whites had higher risk of strokes and bleeding outcomes while on warfarin therapy. Addressing disparities in prevention and healthcare resource allocation could potentially improve AF-related outcomes in minorities.

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