Atrial fibrillation and novel oral anticoagulants

Abstract:

Atrial fibrillation (AFib) is the most common arrhythmia in the general population with a prevalence of 1–2% and a significant increase in incidence with age. AFib is related to an increased risk of stroke and heart failure as well as higher mortality and morbidity of patients. AFib treatment can be divided into prevention of thromboembolism and reducing the risk of stroke and into rhythm control or rate control therapy. According to current knowledge, only anticoagulation therapy has undoubtedly been proven to decrease the overall patients’ mortality. Until recently, the only available anticoagulation therapy was vitamin K antagonists. However, we are faced with numerous disadvantages of the latter – interaction with food and drugs, slow effect onset and stop, as well as the need for continuous effect monitoring for the purpose of dosage modification. Novel oral anticoagulants – NOACs (apixaban, dabigatran, rivaroxaban and edoxaban) have shown in large randomized studies the non-inferiority or even superiority to warfarin in the prevention of ischemic stroke and systemic embolism as well as to the incidence of major bleeding in patients with non-valvular atrial fibrillation. In addition to clinical efficiency, the potential advantage of NOACs is fixed dosage, predictable effects, fewer interactions with other medications and food as well as a rapid effect onset. NOACs are absolutely contraindicated in patients with mechanical valves and moderate or severe mitral stenosis.

Key words:
anticoagulation therapy; atrial fibrillation; NOAC; stroke