Anticoagulation strategies for stroke prevention in atrial fibrillation: a comprehensive review of current literature
Abstract
Atrial fibrillation (AF) significantly increases stroke risk and hence requires anticoagulation for the prevention of stroke. This review discusses strategies of anticoagulation, including the paradigm shift from traditional vitamin K antagonists (VKAs), such as warfarin, to direct oral anticoagulants (DOACs): dabigatran, rivaroxaban, apixaban, and edoxaban. VKAs are effective but require regular monitoring of international normalized ratio and also pose challenges because of their drug and dietary interactions. In contrast, DOACs provide predictable pharmacokinetics, fewer interactions, and no requirement for routine monitoring, and their use is increasingly favored in clinical practice. The review puts an emphasis on the considerations that are patient-specific when choosing an anticoagulant agent, including age, renal function, and associated diseases; stroke risk or risk factors for bleeding; and it explains how tools such as the use of CHA2DS2-VASc and HAS-BLED scores can be relevant for assessing stroke and bleeding risk, respectively. Also, it is explored that the use of emerging therapies like factor XI inhibitors and combinations such as dual antiplatelet therapy with anticoagulants has the potential to provide maximum stroke prevention but fewer bleeding complications. This review evaluated the effect of reversal agents for anticoagulants that may act as a safety measure during instances of serious bleeding. In summary, AF anticoagulation has to be individually tailored based on patient characteristics and meticulous reading of clinical guidelines. As much as DOACs present a tremendous step forward in stroke prevention related to AF, future studies and emerging treatments show promise to further optimize therapeutic outcomes.
Date
2025-05-12
Type
Article
Subject
Atrial fibrillation, Anticoagulants, Stroke, Warfarin
Collections
Citation
Castro-Vidal ZA, Gandapur A, Prakash R, Azab K, Nayyar K, Rinkoo F, Kommuru S, Elsoussi Y, Bojanki NLSVA, Yennam AK, Nishat SM, Motwani J. Anticoagulation strategies for stroke prevention in atrial fibrillation: a comprehensive review of current literature. Ann Med Surg (Lond). 2025 May 12;87(6):3691-3699. doi: 10.1097/MS9.0000000000003364.
Journal / Source Title
Annals of Medicine and Surgery
DOI
10.1097/MS9.0000000000003364
PMID
40486638
Publisher
Wolters Kluwer
Publisher’s URL
https://journals.lww.com/annals-of-medicine-and-surgery/pages/default.aspx
https://www.sciencedirect.com/journal/annals-of-medicine-and-surgery
https://www.sciencedirect.com/journal/annals-of-medicine-and-surgery